耐头孢哌酮-舒巴坦鲍曼不动杆菌分子流行病学调查.doc

耐头孢哌酮/舒巴坦鲍曼不动杆菌分子流行病学调查 　【摘要】 目的 调查重庆某三甲医院2004年11月至2005年9月显著增多的耐头孢哌酮/舒巴坦鲍曼不动杆菌之间的同源性，了解是否有该耐药株暴发流行。方法 用脉冲场凝胶电泳(PFGE)对28株具有相同耐药模式的耐头孢哌酮/舒巴坦鲍曼不动杆菌进行分型，明确其是否为同一菌株的克隆。结果 28株鲍曼不动杆菌PFGE图谱分为A(A1、A2、A3)、B(B1、B2)、C、D、E五型，其中主要流行型A1亚型11株，流行型B1亚型9株，剩余8株中A2亚型2株，A3亚型2株，B2亚型1株，C型2株，E型1株。A1亚型和B1亚型来源于呼吸科，并在外科病区的胸外科、脑外科、肝胆外科已存在9个月左右；A2亚型、A3亚型、B2亚型和C型2株于2005年6月开始出现于胸外科和肝胆外科。结论 2004年11月至2005年9月该院出现了由2个克隆株引起耐头孢哌酮/舒巴坦鲍曼不动杆菌的暴发流行，结合临床资料和科室地理位置分析，医务人员的手污染可能是引起本次暴发感染的重要感染源和感染途径。 【关键词】 不动杆菌属； 头孢哌酮/舒巴坦； 耐药性； 脉冲场凝胶电泳 ABSTRACT Objective To learn an outbreak of Acinetobacer baumannii by investigating the homogeneity of the unusually increasing cefoperazone/sulbactam -resistant Acinetobacer baumannii isolates from November 2004 to September 2005 in a hospital in Chongqing. Methods The pulse-field gel electrophoresis (PFGE) was used for genotyping of 28 strains of Acinetobacer baumannii with the same resistance pattern and determining whether they derived from the same clone. Results Twenty eight strains were classified into 5 types based on PFGE profiles, named type A (A1, A2 and A3), B (B1 and B2), C, type D and E. There were 11 strains typing A1 and 9 strains typing B1 respectively, and the rest were identified: two in type A2, two in type A3, one in type B2, two in type C and one in type E. Both type A1 and type B1 originated from respira-tory department were transmitted to deparments of cerebral surgery, chest surgery and hepatobiliary surgery during 9 months, while type A2, type A3, type B1 and type C have existed in departments of chest surgery and hepatobiliary surgery since June 2005. Conclusions An outbreak of cefoperazone/sulbactam -resistant Acinetobacter baumannii infection occurred in our hospital from November 2004 to September 2005, which was caused by two major clones, type A and type B. Combined with clinical data and epidemic location, the investigation showed that contaminated hands of staffs may be the infective origin and the route of transmission. KEY WORDS Acinetobacter;