摘要
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 investigate a potential outbreak of Stenotrophomonas maltophilia (pma) infection occurred in patients on mechanical ventilation in a respiratory ICU (RICU) and to track the infective origins by antibiotype and pulsed-field gel electrophoresis (PFGE) typing methods. Methods (1) Thirteen pma strains were isolated from 9 patients on mechanical ventilation (9 strains) , hand swabs of medical staffs in RICU(2 strains) and fiberscope used for intubations and aspiration(2 strains) from December, 2002 to February, 2003. (2) Sixteen strains gathered from different wards during the period of 1997-2000 were collected and used as control. (3) Antibiotic susceptibility data of all strains were collected. (4) Homology of the strains was analyzed by the methods of antibiotype and PFGE genotype. Results Of the 9 pma isolated from patients on mechanical ventilation, eight had identical PFGE genotype. The isolates from two RICU staffs and two fiberscope displayed the same genotype with the eight patients above. Seven of the 9 isolates shared an identical antibiotype. The consistent rate of antibiotype with PFGE genotype was 85%(11/13). There were 11 PFGE genotypes and 9 antibiotypes in 16 strains of the control group, which indicated that they came from different clones. Conclusions Eight pma strains of patients in RICU came from the same clone. This result proved that clone transmission occured in patients on mechanical ventilation. Contaminated fiberscope and hands of staffs may be the infective origin and the route of transmission.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2005年第5期310-314,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家教委西部高校高级访问学者李嘉诚基金资助项目[教技厅函(2002)3号]
