CAJ | 학술논문

目的：分析从绍兴市中心医院重症监护室（ ICU）内血流感染患者中分离的粘质沙雷菌株的同源性和耐药情况，为临床合理用药及感染控制提供依据。方法收集ICU病房2013年6月至2013年9月血流感染中分离培养出来的粘质沙雷菌株，并从ICU医务人员手上采集细菌，进行分离培养。对培养出的17株粘质沙雷菌进行药敏检测，用PCR技术扩增常见耐药基因，使用脉冲场凝胶电泳（ PFGE）技术进行同源性分析。收集患者的临床资料，用Spearman相关法进行统计学分析。结果17株粘质沙雷菌对第一代、二代头孢霉素、庆大霉素、环丙沙星耐药率100％，对阿米卡星及头孢他啶敏感，对碳青酶烯类的耐药率为11．76％～35．29％，PCR扩增结果显示1（5．88％）株粘质沙雷菌携带TEM基因，17株粘质沙雷菌PFGE分型一致。结论粘质沙雷菌是重要的致病菌，存在着院内传播现象，具有多重耐药性。临床应根据药敏试验合理选用抗菌药物，加强感染控制，防止耐药菌株在院内交叉传播和暴发流行。
목적：분석종소흥시중심의원중증감호실（ ICU）내혈류감염환자중분리적점질사뢰균주적동원성화내약정황，위림상합리용약급감염공제제공의거。방법수집ICU병방2013년6월지2013년9월혈류감염중분리배양출래적점질사뢰균주，병종ICU의무인원수상채집세균，진행분리배양。대배양출적17주점질사뢰균진행약민검측，용PCR기술확증상견내약기인，사용맥충장응효전영（ PFGE）기술진행동원성분석。수집환자적림상자료，용Spearman상관법진행통계학분석。결과17주점질사뢰균대제일대、이대두포매소、경대매소、배병사성내약솔100％，대아미잡성급두포타정민감，대탄청매희류적내약솔위11．76％～35．29％，PCR확증결과현시1（5．88％）주점질사뢰균휴대TEM기인，17주점질사뢰균PFGE분형일치。결론점질사뢰균시중요적치병균，존재착원내전파현상，구유다중내약성。림상응근거약민시험합리선용항균약물，가강감염공제，방지내약균주재원내교차전파화폭발류행。
Objective To provide the guidance for the control and treatment of blood stream infec-tion caused by Serratia marcescens strains through analyzing the homology and drug resistant genes of the iso-lates collected from the Intensive Care Unit ( ICU) of Shaoxing County Central Hospital.Methods Serratia marcescens strains were isolated from ICU patients with blood stream infection and also from the hands of health care providers in the ICU from June 1st to September 30th, 2013.The antibiotic susceptibilities of the Serratia marcescens isolates were tested.PCR was performed to amplify the common drug resistant genes. Pulse-field gel electrophoresis ( PFGE) was carried out for analyzing the homology of all isolates.The com-plete clinical data of the patients were collected and statistically analyzed with Spearman′s rank correlation coefficient.Results Seventeen strains were isolated in this study.All of the 17 strains were resistant to the first and second generation Cephalosporin, Gentamicin and Ciprofloxacin, and sensitive to Amikacin and Ceftazidime.The drug resistant rates to Carbapenems ranged from 11.76%to 35.29%.One of the isolates (5.88%) carried the TEM gene.The results of PFGE showed that the phenotypes of all isolates were identi-cal.Conclusion Serratia marcescens strains were critical hospital infectious pathogens.They were able to spread in the hospital and were resistant to multiple antibiotics.Clinical physicians should properly use anti-biotics for the patients based on the result of drug susceptibility test.A control regulation for Serratia marces-cens infection within hospital should be enforced to avoid the cross infection and the outbreak of resistant strains.