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目的调查医院鲍氏不动杆菌(Ab)肺炎的分子流行病学特征和耐药性,探讨其传播途径,为临床治疗提供参考依据。方法采用信息系统收集2013年7月-2015年6月患者的临床资料,使用脉冲场凝胶电泳(PFGE)对Ab进行分子分型,采用琼脂扩散法(K-B)测定抗菌药物敏感性。结果 114名医院获得性Ab肺炎患者的病死率为43.86%;菌株共分为A~Q 17种基因型,包括:99株流行株(A~E)和15株散发株(F~Q),主要分布于重症监护室(ICU);药敏试验结果显示:流行株均为多药耐药鲍氏不动杆菌(MDRAB),其中耐碳青霉烯类鲍氏不动杆菌(CRAB)占95.96%,仅对头孢哌酮/舒巴坦和替加环素保持较高敏感性。结论医院存在Ab多克隆流行,对多数抗菌药物耐药率高;感染者间存在交叉传播,途径可能为患者间传播和环境传播;Ab引起的医院获得性肺炎预后差,需采取有效的感染控制措施,预防耐药菌的播散。
Objective To investigate the molecular epidemiological characteristics and drug resistance of Acinetobacter baumannii (Ab) pneumonia in hospital and to explore its route of transmission and to provide a reference for clinical treatment. Methods The clinical data of patients from July 2013 to June 2015 were collected using an information system. Ab was genotyped by pulsed-field gel electrophoresis (PFGE), and antibacterial susceptibility was determined by agar diffusion method (K-B). Results The mortality of 114 hospital-acquired Ab pneumonia patients was 43.86%. The strains were divided into 17 genotypes, including 99 strains of epidemic strains (A ~ E) and 15 strains of sporadic strains (F ~ Q) Mainly distributed in intensive care unit (ICU). The susceptibility test results showed that all the epidemic strains were multi-drug resistant Acinetobacter baumannii (MDRAB), among which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for 95.96 %, Only to cefoperazone / sulbactam and tigecycline to maintain a higher sensitivity. Conclusions Ab polyclonal prevalence exists in hospitals, and the drug resistance rates to most antimicrobial agents are high. Cross-transmission exists among the infected patients, and the transmission pathways may be inter-patient transmission and environmental transmission. Ab-induced poor prognosis of hospital acquired pneumonia requires effective infection control Measures to prevent the spread of resistant bacteria.