内科重症监护病房铜绿假单胞菌医院感染同源性及临床特点

摘要

目的 研究内科重症监护病房(MICU)铜绿假单胞菌(PA)医院感染的同源性及临床特点,以指导临床预防PA传播,提高治疗效果.方法 对某院2014年1—12月MICU发生医院感染的25例患者分离的55株PA进行脉冲场凝胶电泳(PFGE)同源性分析及聚类分析,对其临床特点、耐药性及其传播特点进行分析.结果 共调查25例患者,平均年龄为(69.62±2.13)岁,平均住院时间(49.34±3.18)d;在分离出PA之前,84.00%的患者应用广谱抗菌药物>2周,76.00%的患者入住过MICU,52.00%的患者使用呼吸机辅助通气.55株PA主要以A、F、H、K、N、V、W型为主要的流行菌株;感染A型、F型、H型及K型菌株的患者在各自住院时间上均存在交叉;有4例患者不同时期分离菌株的PFGE图谱分析显示不同菌型;PA对头孢他啶(72.73%)、哌拉西林/他唑巴坦(70.91%)、亚胺培南(70.91%)耐药率高,对阿米卡星耐药率最低(25.45%).结论 医疗机构应加强抗菌药物管理,加强医院感染控制措施,防止多重耐药和泛耐药细菌在医院内的播散.%Objective To study the homology and clinical characteristics of healthcare-associated infection(HAI) due to Pseudomonas aeruginosa (P.aeruginosa)in medical intensive care unit (MICU),so as to guide the clinical prevention of P.aeruginosa transmission and improve therapeutic effect.Methods 55 P.aeruginosa strains isola-ted from 25 patients with HAI in the MICU of a hospital in January-December 2014 were performed pulsed-field gel electrophoresis (PFGE)homology analysis and clustering analysis,clinical characteristics,antimicrobial resistance, and transmission characteristics were analyzed.Results A total of 25 patients were investigated,with an average age of (69.62±2.13)years,mean hospital stay (49.34±3.18)days;prior to the isolation of P.aeruginosa, 84.00% of patients were treated with broad-spectrum antimicrobial agents for >2 weeks,76.00% of patients had been admitted to MICU,and 52.00% had a ventilator-assisted ventilation.55 strains of P.aeruginosa were mainly A,F,H,K,N,V,and W,which were the main epidemic strains;patients infected with A,F,H and K strains all had cross in their hospital stay;PFGE profiles of isolates from 4 patients during different periods showed different strain patterns;resistance rates of P.aeruginosa to ceftazidime (72.73%), piperacillin/tazobactam (70.91%),and imipenem(70.91%)were all high,resistance rate to amikacin was the lowest(25.45%).Conclusion Management of antimicrobial agents should be strengthened in medical institutions,HAI control meas-ures should be strengthened,so as to prevent the transmission of multidrug-resistant and extensively drug-resistant bacteria in hospitals.