某医院新老病区鲍曼不动杆菌的耐药性和分子流行病学

发布时间：2018-05-24 23:38

本文选题：鲍曼不动杆菌 + 替加环素　；参考：《中南大学》2011年硕士论文

【摘要】：研究目的： 1.研究我院鲍曼不动杆菌临床分离株的标本来源、科室分布及环境分离株的污染源。 2.研究我院鲍曼不动杆菌对12种抗菌药物的耐药性,为指导临床合理制定治疗方案提供依据。 3.了解我院鲍曼不动杆菌基因型及主要流行型别,分析基因型与耐药表型的相关性,研究院内鲍曼不动杆菌菌株之间的同源性,确定医院感染是否暴发流行,探讨耐药菌的传播机制。 4.对比分析我院老病区和新病区临床分离株耐药率和基因型的差异,探讨交叉感染与医院环境的相关性,说明医院环境卫生的重要性。研究方法： 1.收集我院新老病区鲍曼不动杆菌临床分离株共91株,同时从老病区的ICU、呼吸科、中西医结合科及新病区的呼吸科、中西医结合科、ICU、急诊ICU病房环境中采样,进行常规分离鉴定出鲍曼不动杆菌,共收集到68株。 2.采用K-B药敏纸片法对所有收集到的鲍曼不动杆菌对12种抗菌药物进行敏感试验。 3.采用肠杆菌科基因组内重复序列聚合酶链反应(ERIC-PCR)进行基因同源性分析。 4.用SPSS.V10.0统计软件对数据进行统计学分析。 5.运用卡方检验对新老病区的耐药率进行比较。研究结果： 1.标本来源和科室分布：91株临床分离株：主要来源于神经内科、神外科、ICU、呼吸科,占全院科室的60.43%,其中78株分离于呼吸道标本(痰和支气管吸引物),占85.71%。68株环境分离株：广泛分布于各物体表面,以患者床桌(25株)为主,占36.76%,其次各类导管(6株)占11.76%。 2.耐药性分析：在12种抗菌药物中,我院共159株鲍曼不动杆菌对替加环素耐药率为0%、亚胺培南27.04%、美罗培南27.67%、头孢哌酮/舒巴坦13.21%,其余在35.22%-57.23%。比较新老病区的耐药率,除亚胺培南、美罗培南二者外均具有统计学差异。无论老病区或是新病区,环境分离株比临床分离株耐药率均低。无论临床分离株或是环境分离株,新病区耐药率均比老病区低。我院多重耐药菌株平均占44.03%(70/159),新病区(32.56%)比老病区(57.53%)低. 3.重复片段引物PCR基因分型： 1)159株鲍曼不动杆菌：共分为29型,其中A型最多,占35.22%。老病区73株鲍曼不动杆菌分19型,A型(40株)占54.79%。新病区86株鲍曼不动杆菌分23型,A型(16株)占18.60%。 2)我院鲍曼不动杆菌临床分离株A型(43株)主要分布在神经内科(10株)、神经外科(7株)、ICU科室(11株)。环境分离株A型(13)主要分离自新病区中西医结合科室的一位患者床桌上、急诊ICU病房中的一个回风口及监护仪台面及老病区ICU病房中床桌、床沿、被子、鼻导管、气切管、吸痰管。无论临床分离株或是环境分离株,新病区A型所占比例均比老病区低。无论老病区或是新病区,环境分离株A型所占比例均比临床分离株A型低。 3)基因A型菌株在耐药谱上均表现为多重耐药性。研究结论： 1.我院神经内科、神经外科、ICU、呼吸科应作为重点科室来防止鲍曼不动杆菌的交叉感染。病房里的床桌表面应注意清洁消毒。 2.在12种抗菌药物中,我院鲍曼不动杆菌除对新药替加环素、头孢哌酮/舒巴坦、亚胺培南、美罗培南保持一定敏感性外,其余均高度耐药,且多重耐药株所占比例大,新病区的耐药率和多重耐药比例较老病区均低。无论老病区或是新病区,环境分离株耐药率较临床分离株低。说明交叉感染与医院环境卫生具有统一性。 3.我院鲍曼不动杆菌基因型分29型,以A型菌株流行为主,广泛分布于各临床科室,但主要分布在神经外、神经内科、ICU科室。临床菌株与环境菌株之间具有同源性。同一克隆株在一个病房内和各个病房之间播散。老病区ICU病房及新病区神经内科病房存在感染暴发。鲍曼不动杆菌暴发流行的传播机制可能是通过感染患者污染的病房用具或器械及医护手再传播至患者。 4.基因型与耐药谱有一定相关性。 5.A型菌株在药敏谱中均表现为多重耐药性；新病区比老病区基因型别更多,呈现出多样性。虽都以A型菌株为主,但A型菌株所占比例明显下降,这就是为什么耐药率和多重耐药比例也下降。无论老病区或是新病区,环境分离株A型株所占比例较临床分离株低。说明交叉感染与医院环境卫生具有统一性。 6.物体表面的清洁消毒与手卫生对防止鲍曼不动杆菌院内交叉感染具有重要意义。
[Abstract]:The purpose of the study is:
1. to study the sources, distribution and pollution sources of clinical isolates of Acinetobacter baumannii isolated from our hospital in Bauman.
2. to study the resistance of Acinetobacter baumannii to 12 kinds of antibiotics in our hospital, so as to provide evidence for guiding the rational formulation of treatment plan in.
3. to understand the genotypes and main epidemic types of Acinetobacter Bauman in our hospital, to analyze the correlation between genotypes and drug-resistant phenotypes, to study the homology of Acinetobacter Bauman in hospital, to determine whether the nosocomial infection is outbreak and to explore the transmission mechanism of drug-resistant bacteria.
4. the difference of resistance rate and genotype of clinical isolates in old ward and new ward of our hospital was compared and analyzed. The correlation between cross infection and hospital environment was discussed, and the importance of hospital environmental sanitation was explained.
Research methods:
1. a total of 91 clinical isolates of Acinetobacter Bauman were collected from the new and old sick area of our hospital. At the same time, 68 strains of Acinetobacter Bauman were collected and identified from the old ward ICU, Department of respiration, the Department of respiration in the integrated traditional Chinese and Western medicine and the new ward, the integrated traditional Chinese and Western medicine, the ICU and the emergency ICU ward.
2. K-B susceptibility test was used to test all the collected Acinetobacter baumannii strains on 12 kinds of antimicrobial agents. Bauman
3. genetic homology analysis was performed using Enterobacteriaceae genome repeat polymerase chain reaction (ERIC-PCR).
4. statistical analysis was performed using SPSS.V10.0 statistical software.
5. chi square test was used to compare the resistance rates in new and old wards.
The results of the study:
1. source of specimen and section distribution: 91 strains of clinical isolates: mainly from neurology, God surgery, ICU, and Department of respiration, accounting for 60.43% of the whole hospital department, 78 of which were isolated from respiratory specimens (sputum and bronchus attraction), accounting for 85.71%.68 strains of environmental isolates, widely distributed on the surface of each body, mainly in bed table (25 strains), accounting for 36.76%, Secondly, all kinds of ducts (6 strains) accounted for 11.76%.
2. drug resistance analysis: among the 12 kinds of antibiotics, 159 strains of Acinetobacter of Bauman in our hospital were resistant to tegacycline 0%, imipenem 27.04%, meropenem 27.67%, Cefoperazone / sulbactam 13.21%, and the remainder in the 35.22%-57.23%. compared to the new and old ward, except imipenem and meropenem two. The resistance rate of the environmental isolates was lower than that of the clinical isolates. The drug resistance rate in the new ward was lower than that in the old ward. The multidrug-resistant strains in our hospital accounted for 44.03% (70/159), and the new disease area (32.56%) was lower than that of the old ward (57.53%).
3. repeat fragment primers PCR genotyping:
1) 159 strains of Acinetobacter Bauman: type 29, of which type A was the most, accounting for 73 strains of Acinetobacter Bauman in the old disease area, 19 type, A type (40 strains), 86 strains of Acinetobacter Bauman in 54.79%. new ward, and A type (16 strains) accounting for 18.60%..
2) in our hospital, the clinical isolates of Acinetobacter Bauman (43 strains) were mainly distributed in the neurology department (10 strains), Department of Neurosurgery (7 strains), and the ICU Department (11 strains). The environmental isolates A type (13) mainly separated a patient on the bed table of the integrated traditional Chinese and Western Medicine Department of the new ward, a back air outlet and the monitor table in the emergency ICU ward and the bed in the ICU ward of the old disease area. Table, bedside, quilt, nasal catheter, gas cut tube, sputum suction tube. The proportion of A type in the new disease area is lower than that in the old ward, no matter the clinical isolates or the environmental isolates. The proportion of the A type of the environmental isolates is lower than that of the clinical isolates A.
3) genotype A strains showed multiple resistance to drug resistance.
The conclusions are as follows:
1. the Department of Neurology, Department of Neurosurgery, ICU, the Department of respiration should be the key department to prevent the cross infection of Acinetobacter Bauman in our hospital. The bed table in the ward should pay attention to the cleaning and disinfection.
2. of the 12 antimicrobial agents, Acinetobacter Bauman in our hospital was highly resistant to the new drug tegenin, Cefoperazone / sulbactam, imipenem, meropenem, and the remainder were highly resistant, and the proportion of multidrug-resistant strains was large. The rate of resistance and multidrug resistance in the new ward area were lower than that in the old disease area. The resistance rate of the isolates was lower than that of the clinical isolates, indicating that the cross infection is consistent with the hospital environmental hygiene.
3. the genotypes of Acinetobacter Bauman in our hospital were divided into 29 types, which were mainly distributed in various clinical departments, but mainly distributed in the clinical departments, but mainly in the external nerve, neurology department and the ICU department. The clinical strain was homologous to the environmental strain. The same clone spread between the ward and the ward. The ICU ward and the new ward nerve in the old disease area. There is an outbreak of infection in the medical ward. The transmission mechanism of the outbreak of Acinetobacter Bauman may be transmitted to patients through infected ward equipment or equipment and medical hands.
There is a certain correlation between the 4. genotypes and the drug resistance spectrum.
The strains of type 5.A were multiple drug resistance in the drug sensitivity spectrum, and the new disease areas were more diverse than the old ones. Although all of them were mainly A strains, the proportion of A strains decreased significantly. This is why the resistance rate and the proportion of multidrug resistance also declined. No matter in the old or the new areas, the environmental isolates accounted for the A strain. The ratio is lower than that of clinical isolates, indicating that cross infection is consistent with hospital environmental hygiene.
6. cleaning and disinfection of hands and hand hygiene are important for preventing cross infection of Acinetobacter Bauman.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R446.5;R181.3

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