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目的对某医院中心重症监护病房(ICU)2007年1月-2009年7月3次疑似多药耐药鲍氏不动杆菌(MDRAB)医院流行时间段内的MDRAB进行同源性分析。方法收集ICU住院患者标本中分离的28株MDRAB,以及从该病房环境中分离的7株ABA;运用脉冲场凝胶电泳分析菌株的同源性。结果脉冲场凝胶电泳结果表明,36株菌有4个克隆,其中克隆A包括临床分离株648,3个环境分离株B8、J4、C9;B型、C型全为临床分离株,分别包括1196、1201、1103、1205、1150和3325、3693、3334、3893、4006、4128、4358、3605;D型包括3次临床分离株433、438、458及一个环境分离株(B15)。结论 3次医院流行分别由克隆D、B、C引起,患者间MDRAB的交叉传播是医院流行的主要传播方式,环境样品分离鉴定及同源性分析结果提示,ICU的通风系统是MDRAB流行的源头;严格的消毒、隔离措施,强调手卫生,能有效控制MDRAB的医院流行。
OBJECTIVE: To analyze the homology of MDRAB during the prevalence of suspected multidrug-resistant Acinetobacter baumannii (MDRAB) hospital from January 2007 to July 2009 in a hospital intensive care unit (ICU). Methods 28 MDRAB isolates from ICU inpatients and 7 ABA isolates from the ward environment were collected. The homologies of strains were analyzed by pulsed-field gel electrophoresis. Results The results of pulsed-field gel electrophoresis showed that 36 strains had 4 clones, of which clone A included clinical isolates 648 and 3 environmental isolates B8, J4 and C9; type B and C were all clinical isolates, including 1196,1201,1103,1205,1150 and 3325,3693,3334,3893,4006,4128,4358,3605; Type D includes three clinical isolates 433,438,458 and one environmental isolate (B15). Conclusions The prevalence of three hospitals was caused by clones D, B and C respectively. The cross transmission of MDRAB among patients was the main mode of transmission in hospitals. Isolation, identification and homology analysis of environmental samples suggested that the ventilation system of ICU was the source of MDRAB epidemic Strict disinfection, isolation measures, emphasis on hand hygiene, can effectively control the MDRAB hospital epidemic.