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目的研究确定呼吸重症监护室(RICU)内机械通气患者连续发生嗜麦芽窄食单胞菌(pma)感染为暴发感染,并追踪其感染源。方法收集2002年12月至2003年2月自RICU有创机械通气患者气道抽吸物中分离出的9株pma菌株,RICU工作人员手拭子分离的pma菌株2株,纤维支气管镜(已按常规消毒存放,用于气道管理)冲洗液分离的pma菌株2株,采用WHONET5软件通过耐药分析组合对菌株进行抗生素型分析,通过脉冲场凝胶电泳(PFGE)全DNA指纹图技术对菌株进行分子分型,确定菌株的亲缘关系。以1997年至2000年自多个科室收集的16株pma作对比。结果9例机械通气患者感染的9株pma,有8株PFGE基因型相同,并与2株分离自RICU工作人员手拭子的pma和2株分离自纤维支气管镜的pma基因型一致。抗生素型则有7株分型相同。抗生素型与PFGE基因型的符合率为85%(11/13)。1997年至2000年收集的16株pma,PFGE基因型分为11型,抗生素型分为9型,呈现为多克隆构成模式。结论8例机械通气患者感染的pma来自于同一克隆,RICU内存在着pma的暴发感染。消毒不彻底的纤维支气管镜和医护人员的手污染是引起本次暴发感染的重要感染源和感染途径。
Objective To study the continuous occurrence of pma infection in patients with mechanical ventilation in respiratory intensive care unit (RICU) as outbreak and to track the source of infection. Methods Nine strains of pma isolated from airway aspirates from RICU patients with invasive mechanical ventilation were collected from December 2002 to February 2003. Two strains of pma isolates were hand-swab-separated by RICU staff. Fiberoptic bronchoscopy Routine disinfection and storage for airway management), two strains of pma isolated from the washings were used. The strains were analyzed by antibiotic resistance using WHONET5 software. The genotypes of the isolates were analyzed by pulse-field gel electrophoresis (PFGE) Molecular typing to determine the strains of kinship. The comparison of 16 pma collected from multiple departments from 1997 to 2000. Results Nine of nine pma infected in 9 patients with mechanical ventilation had the same genotype of 8 PFGE and were consistent with 2 strains of pma isolated from RICU staff hand swab and 2 strains of pma isolated from bronchoscopy. Antibiotics are 7 strains of the same type. The coincidence rate of antibiotic and PFGE genotypes was 85% (11/13). From 1997 to 2000 collected 16 strains of pma, PFGE genotypes are divided into 11 types, antibiotic type is divided into 9, presented as a polyclonal constitutive model. Conclusion The infection of pma from 8 patients with mechanical ventilation is from the same clone, and outbreak infection of pma exists in RICU. Incomplete disinfection of fiberoptic bronchoscopy and medical staff hand contamination is caused by this outbreak of infection is an important source of infection and infection.