北京世纪坛医院亚胺培南耐药肺炎克雷伯菌院内感染流行病学调查

目的 探讨临床分离亚胺培南耐药肺炎克雷伯菌菌株间同源性关系及耐药菌可能的传播途径,为临床该类菌的传播控制提供依据.方法 常规进行临床样本采集及细菌培养;同时对ICU病房医护人员手表面及患者床旁物品表面采样并做细菌计数及培养;细菌鉴定及药敏测定采用VITEK-2 COMPACT全自动细菌鉴定/药敏分析系统;细菌同源性测定采用肠杆菌科基因组内重复序列聚合酶链反应(ERIC-rep-PCR)法.结果 2011年1月至2013年12月临床共分离到642株亚胺培南耐药肺炎克雷伯菌,菌株来源为ICU 389株(60.59％);呼吸内科72株(11.21％);神经内科53株(8.26％);心血管科41株(6.39％);外科31株(4.83％);消化内科11株(1.71％);肾脏内科5株(0.78％);急诊科17株(2.65％);其他科室23株(3.58％).ICU物体表面分离到1株亚胺培南耐药肺炎克雷伯菌.642株临床菌株中含8个主要克隆,该8个克隆菌合计394株,占全部菌株的61.37％,其余248株菌为单一克隆.结论 亚胺培南耐药的肺炎克雷伯菌在该院确实存在单克隆流行,接触传播可能是此类感染的传播途径.

Epidemiological survey of nosocomial infection of imipenem-resistant Klebsiella pneumoniae in Beijing Shijitan Hospital

Objective To study the homology relationship among clinically isolated imipenem-resistant klebsiella pneumoniae strains and possible transmission route of drug resistant strains to provide a basis for blocking the transmission of this kind of bacteria in clinc.Methods Clinical samples collection and bacterial culture were routinely conducted,meanwhile the hand surface of ICU medical staffs and the surfaces of patien's bedside objects were performed the sample collection for conducting the bacterial count and culture.The bacterial identification and drug susceptibility test were performed by the VITEK-2 COMPACT system.The bacterial homology detection adopted the ERIC-rep-PCR method.Results Totally 642 strains of imipenem-resistant Klebsiella pneumoniae were clinically isolated from January 2011 to December 2013.Among them,389 strains(60.59％) were derived from ICU.72 strains (11.21％) fsrom the respiratory department,53 strains (8.26％) from the neurology department,41 strains (6.39 ％) from the cardiovascular department,31 strains (4.83％) from the surgical department,11 strains (1.71％) from the gastroenterology department,5 strains (0.78 ％) from the renal department,17 strains (2.65 ％) from the emergency department and 23 strains(3.58％) from the other departments.One strain of imipenem-resistant Klebsiella pneumoniae was isolated from the IGU object surface.Among 642 clinical bacterial strains,there were 8 main clones,these 8 clone strains added up to 394 strains,which accounted for 61.37％ of whole bacterial strains,the other 248 strains were single clones.Conclusion The monoclonal prevalence of imipenem-resistant klebsiella pneumonia in this hospital actually exists.The contact transmission may be the possible transmission route of this kind of infection.