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目的:监测ICU医护人员、住院患者,及环境中MRSA的携带及分布情况,以提出针对性预防与控制措施。方法:对本院ICU的20位医护人员、8例住院患者的手、咽和鼻前庭等部位,及ICU环境中的物体表面和空气同时进行采样,采用免疫富集-显色培养基分离MRSA,应用VITEK 32全自动微生物分析仪进行菌种鉴定和药敏试验;对MRSA进行随机引物扩增多态DNA检测并进行同源性分析;比较MRSA的耐药谱分型和随机扩增多态性DNA基因分型之间的差异,判断医护人员、住院患者及环境中分离的MRSA的相关性。结果:共检出31株MRSA,20位医护人员11位检出15株MRSA,8位患者5位检出9株MRSA,分离于同一个体不同部位的重复分离株经随机扩增多态性DNA同源性分析均为同一克隆菌株。52份环境物体表面检出7株MRSA。根据随机扩增多态DNA聚类分析可以将检出的MRSA分为3个类型。结论:医护人员MRSA带菌率较高,部分医务人员、住院患者和环境中分离的MRSA有较高的同源性,ICU存在人与人和人与环境之间的MRSA传播。
OBJECTIVE: To monitor the carrying and distribution of medical staff in ICU, hospitalized patients and MRSA in the environment so as to put forward targeted prevention and control measures. Methods: Twenty medical staff in ICU, 8 patients in hospital, pharynx and nasal vestibule, and the surface and air of ICU environment were sampled at the same time. MRSA was separated by immunoenrichment-chromogenic medium , Using VITEK 32 automatic microbial analyzer strain identification and drug susceptibility testing; MRSA primers for random amplified polymorphic DNA detection and homology analysis; comparison MRSA spectrum of drug resistance and random amplified polymorphic Sex DNA genotyping differences to determine the correlation between medical staff, hospitalized patients and the environment isolated MRSA. Results: A total of 31 strains of MRSA were detected. Eleven of 20 medical staffs detected 15 strains of MRSA. Five of the 8 patients detected 9 strains of MRSA. Repeated isolates isolated from different parts of the same individual were randomly amplified by random amplified polymorphic DNA Homology analysis is the same clonal strain. Seventy MRSA strains were detected on the surface of 52 environmental objects. According to the random amplified polymorphic DNA cluster analysis, the detected MRSA can be divided into three types. CONCLUSIONS: The prevalence of MRSA in healthcare workers is relatively high. Some medical staff, hospitalized patients and MRSA isolated in the environment have higher homology. MRS transmission between people and people and between people and the environment exists in the ICU.