CAJ | 학술논문

目的：了解我院ICU环境中多重耐药鲍曼不动杆菌的主要流行菌株型，为医院感染病原菌的溯源提供数据支持。方法2010年10月1日-2011年10月1日，每隔2周对外科监护室、神经内科监护室和呼吸科监护室病人周边环境连续采样分离鲍曼不动杆菌，采用V-teck对15种抗生素的药物敏感性进行检测，并采用脉冲场凝胶电泳对环境多重耐药菌分离株进行基因多态性分析；选取病人多重耐药鲍曼不动杆菌分离株4株作为基因型对照。结果监测期间共收集7878份环境标本，分离鲍曼不动杆菌229株，其中多重耐药鲍曼不动杆菌分离率为1.13%(89/7878)，3个监护室多重耐药鲍曼不动杆菌污染程度差异无统计学意义(P＞0.05)；89株环境分离多重耐药鲍曼不动杆菌和4株患者鲍曼不动杆菌的基因图谱总体分散，当相似性系数为40%时，可分为A、B、C 3大聚类。89株环境菌株以A2亚类为主(占24.7%)，其次为A1亚类和A8亚类(各占15.1%)，时间和空间上未见集中趋势。在同一监护室和不同监护室间同源性>90%的病人和环境分离株，在时间和空间上没有流行病学关联。结论3个监护室在1年的连续监测期间，多重耐药鲍曼不动杆菌基因型呈多样性，未发现耐药菌株的传播，所收集的多重耐药菌株在抗生素的选择压力下源自于环境菌群。
목적：료해아원ICU배경중다중내약포만불동간균적주요류행균주형，위의원감염병원균적소원제공수거지지。방법2010년10월1일-2011년10월1일，매격2주대외과감호실、신경내과감호실화호흡과감호실병인주변배경련속채양분리포만불동간균，채용V-teck대15충항생소적약물민감성진행검측，병채용맥충장응효전영대배경다중내약균분리주진행기인다태성분석；선취병인다중내약포만불동간균분리주4주작위기인형대조。결과감측기간공수집7878빈배경표본，분리포만불동간균229주，기중다중내약포만불동간균분리솔위1.13%(89/7878)，3개감호실다중내약포만불동간균오염정도차이무통계학의의(P＞0.05)；89주배경분리다중내약포만불동간균화4주환자포만불동간균적기인도보총체분산，당상사성계수위40%시，가분위A、B、C 3대취류。89주배경균주이A2아류위주(점24.7%)，기차위A1아류화A8아류(각점15.1%)，시간화공간상미견집중추세。재동일감호실화불동감호실간동원성>90%적병인화배경분리주，재시간화공간상몰유류행병학관련。결론3개감호실재1년적련속감측기간，다중내약포만불동간균기인형정다양성，미발현내약균주적전파，소수집적다중내약균주재항생소적선택압력하원자우배경균군。
Objective To detect the genotypes of Acinetobater baumannii isolated from ICU environments, and provide basis for hospital infection investigation.MethodsThe environmental samples from surgical ICU, neurological ICU and respiratory ICU were collected every two weeks continually from October 2010 to October 2011 and Acinetobacter baumannii strains were isolated. The antibiotic susceptibility of 15 kinds antibiotics were detected by V- teck. The genotype polymorphism of multi-drug resistant Acinectobacter baumannii stains was examined by pulsed-field gel electrophoresis (PFGE). Four strains from patients were selected as the genotype control.ResultsA total of 7 878 samples were collected. Among 229 Acinetobacter baumannii stains, the isolated rate of multi-drug resistant strains was 1.13% (89/7 878). The distribution of multi-drug resistant Acinectobacter baumannii in three ICU had no significant difference (P>0.05). There was no central tendency of the genotypes among the 89 multi-drug resistant isolates, of which three types (class A, B and C) were clustered at the similarity of 40%. The subtype A2 was the main type (24.7%), followed by the subtype A1 and A8, which accounted for 15.1% and 15.1%, respectively. No central tendency was showed in time and space. The patients and the environmental isolates with the similarity of 90% in the same or different ICU showed no epidemiological association.ConclusionDuring the monitoring period, the genotypes polymorphism of antibiotic resistant Acinectobacter baumannii isolated from three ICU environment show no central tendency, which suggests that the isolates come from environmentalflora under antibiotic pressure.