本文選題：肺炎克雷伯菌 + 碳青霉烯酶類抗生素��； 參考：《中國感染控制雜志》2017年08期

【摘要】：目的了解某醫(yī)療機構耐碳青霉烯類肺炎克雷伯菌(CRKP)感染患者臨床分離株與環(huán)境分離株的同源性。方法收集該院1例患者分離的CRKP與該患者周圍環(huán)境中檢出的4例肺炎克雷伯菌,測定5株菌對臨床上常用抗菌藥物的敏感性,利用改良Hodge試驗和CIM(Carbapenem Inactivation Method)試驗檢測5株菌產碳青霉烯酶情況,采用脈沖場凝膠電泳(PFGE)對其進行同源性分析。結果藥敏試驗結果顯示,5株肺炎克雷伯菌(1株來自患者,4株來自于患者所在的病房環(huán)境,分離自護工手、溶液瓶口、升降扶手、床欄桿)除對頭霉素類、氨基糖苷類抗生素的藥敏結果不一致外,對其他各類抗菌藥物均表現(xiàn)為耐藥。改良Hodge試驗和CIM試驗證實5株菌均產碳青霉烯酶;PFGE結果顯示,病房溶液瓶口、床欄桿、病床升降扶手同患者標本分離的CRKP電泳圖譜一致,為同一菌株,而護工手同患者標本分離的CRKP電泳圖譜有2條條帶的差異,其菌株間有相近的關系。結論患者及其周圍環(huán)境檢出同一種CRKP,應嚴格執(zhí)行醫(yī)院感染控制制度,隔離感染患者,加強環(huán)境的清潔與消毒,避免醫(yī)院感染暴發(fā)。
[Abstract]:Objective to investigate the homology between clinical isolates and environmental isolates from patients with Klebsiella pneumoniae (CRKP) infection in a medical institution. Methods one CRKP isolated from one patient and four Klebsiella pneumoniae isolated in the surrounding environment of the patient were collected, and the sensitivity of 5 strains of Klebsiella pneumoniae to the antibiotics commonly used in clinic was determined. The improved Hodge test and CIM (Carbapenem inactivation method) test were used to detect the carbapenem producing enzymes of 5 strains, and their homology was analyzed by pulsed field gel electrophoresis (PFGE). Results the drug sensitivity test showed that 5 strains of Klebsiella pneumoniae (1 strain from the patient and 4 strains from the ward of the patient were isolated from the hands of the nurse, the mouth of the solution bottle, the lifting handrail, the bed railing) except for the cephalomycin. The drug sensitivity of aminoglycoside antibiotics was not consistent, but resistance to other antimicrobial agents was found. The improved Hodge test and CIM test confirmed that all of the five strains produced carbapenem enzyme PFGE. The results showed that the electrophoresis patterns of CRKP isolated from the bottle mouth, bed railings and bed handrails of the five strains were the same as those isolated from the patient's specimen. There were two bands in CRKP electrophoretogram between nurse hand and patient specimen, and there was similar relationship between the two strains. Conclusion the same CRKPs can be detected in patients and their surroundings. The hospital infection control system should be strictly carried out, the infection patients should be isolated, and the environment should be cleaned and disinfected so as to avoid the outbreak of nosocomial infection.
【作者單位】： 第三軍醫(yī)大學附屬西南醫(yī)院;重慶市人民醫(yī)院;
【基金】：國家自然科學基金項目(No.71373280) 第三軍醫(yī)大學臨床創(chuàng)新基金項目(SWH2013LC08,SWH2014LC31)
【分類號】：R446.5

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