SICU多重耐药菌定植感染监测及传播动力学研究
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摘要
随着人口寿命延长,各种慢性病、肿瘤患者逐渐增多,由于治疗的科技水平大幅度提高,各种创伤性和侵入性检查广泛应用,及免疫抑制剂、细胞毒性药物使用,均可使患者免疫功能严重受创并极易发生感染。再加上抗菌药物的广泛应用,滥用、乱用现象日益严重,导致细菌变成多重耐药菌,感染患者愈后极差,治疗十分棘手。目前,医院感染已经成为制约医疗效果的主要负面因素,影响波及全世界,患者病死率极高,与艾滋病、肿瘤并称世界三大医学难题。
开展医院感染监测对于控制管理医院感染有着十分重要的意义,主要包括综合性监测和目标性监测,二者各有局限性。而多重耐药菌的动力学研究在目前国际国内研究中仍处于尝试阶段。因此,开展多重耐药菌定植感染目标性结合全面性监测,同期结合传播动力学研究,分析感染控制措施作用,全面研究多重耐药菌定植感染的关键因素,有助于降低医院感染的流行。
本研究选择一所国内大型综合性医院的外科重症监护病房作为目标性监测对象,采用前瞻性设计,开展住院患者、医护人员和环境因素(空气及物品表面等)的综合性监测。以耐甲氧西林金黄色葡萄球菌和多重耐药鲍曼不动杆菌为目标菌群。监测同期开展多重耐药菌传播动力学研究,主要包括:医患接触率,患者与医务人员数量比,阳性患者转出频率及接触中传播机率等;感染控制措施(医护人员的手卫生和医务人员分组)效果研究。利用该病房搬迁事件,深入分析环境因素与多重耐药菌传播的关系。开展多重耐药菌定植感染监测,减少医务人员病房内接触,适当隔离并加快转出阳性携带患者,加强手卫生宣传监督,建议护士与患者1对1分组原则,加强环境消毒,才能有效地减少多重耐药菌医院内定植感染的发生,为医院感染多重病原体监测和传播动力学的进一步深入发展提供研究依据。
Nosocomial infection had became a worldwide major public health problem, patients with high infection and mortality rate were seriously affected the development of medical standards and gived a heavy burden on families and society. As the abuse and misuse of antibiotics was prevalent, and nosocomial infection characteristics of multi-drug resistant pathogens present, treatment was even more difficult, therefore, prevention and control of nosocomial infection prevalence became particularly necessary. ICU was a high incidence of nosocomial infection departments, methicillin-resistant Staphylococcus aureus and multi-drug resistant Acinetobacter baumannii infections were caused by the incidence of nosocomial infection in the first place. Monitoring colonization and infection of MRSA and MRAB in the SICU, related risk factors analysised , combined with the transmission dynamics parameters and status research of infection control measures (hand hygiene of medical personnel) , in-depth analysis of the key factors about the spread of MRSA and MRAB in this SICU, in order to better prevention and control prevalence of multi-resistant nosocomial infection pathogen, filling research gaps, promoted the nosocomial infection epidemiology to the rapid development of new research directions.
Objective:
To monitor the prevalence of meticillin-resistance Staphylococcus aureus (MRSA) and multi-drug-resistance Acinetobacter banmannii(MRAB) , antibiotics resistance status,;to analyze the risk factors of colonization and infection; to analyze the transmission dynamics study of important parameters and medical personnel hand hygiene status, determine the impact key factors of multi-drug-resistant bacteria in ICU.
Methods:
(1)Monitoring the colonization and infection
The inpatients and healthcare workers in a surgical intensive care unit (SICU) were investigated the colonization and infection of MRSA and MRAB. Patients were screened for MRSA or MRAB colonization within the first 48h of admission and once within two days thereafter, with swab samples taken from the anterior nares, forehead, groins, axillae. In the same period, swab samples taken from the anterior nares of health care workers were obtained at least once monthly, and the propotion of contacts resulting in the hands of health care workers were obtained once within two days, they were collected and also served as screening cultures for MRSA and MRAB. Swab samples collected from the environments nearby patients and work section (e.g., handrail of beds, buttons of equipment, bed sheets, bed table, observation tables and books of nurse, water taps, calculators, tables used to fill prescriptions) were obtained once within four days and also served as screening cultures for MRSA and MRAB. Screening swabs and propotion of all respiratory specimens were inoculated on blood plates and then incubated overnight at 37°C.The resemble colonies of MRSA were identified by presence of protein A, fibrinogen receptor, coagulase and CHROMagar Staph aureus(CSA). The resemble colonies of MRAB were identified by the typical colonies on the blood Plate, 42°C growth, the typical colonies on the China-Blue medium , Triple Sugar Iron Agar and Citrate agar ,seven types of antibiotic susceptibility test (three or more drug-resistant).The seven types of antibiotic is Cefuroxime , Cefepime . Cefotaxime , Imipenem , Amikacin , Minocycline and Levofloxacin .
Risk factor(e,g, age, sex, underlying conditions, reason for admission, urgency of admission, previous hospitalization and origin of referral, immediate unit within the hospital before the ICU, time and place of intubations, Acute Physiology and Chronic Health Evaluation (APACHE) II score at 24h, Glasgow coma score, number of organs that would fail without mechanical or pharmacologic support, duration and type of intubations) analysis included univariate and multivariate approaches.
(2) Investigation of parameters describing strength of transmission
The parameters used were based on daily data collection and direct observation of staff-patient contact patterns. Observed parameters for each monthly interval were admission and discharge rates of colonized and noncolonized patients and average staff numbers. The proportion of staff who did not contribute to transmission, which was equivalent to the cohorting probability, q, the staff-patient contact rate, the probability of hand washing/disinfection, the probabilities of transmission from patient to staff were obtained from investigantion. The possible role of environmentalfactors was analyzed.
Results:
1) ICU moved to a new environment at July 15th 2008, the environment, management and staffs were changed largely.
2) From April 2008 to January 2009.301 patients (admission after 48h) were treated in the ICU during the investigation period. MRSA was colonized from 39 patients, the ratio of colonization is 13.0%.The numbers of patients infected by MRSA is 11, the ratio of infection is 3.7%, the ratio of MRSA positive (colonization/infection) is 13.6%, the ratio of after admission of MRSA positive is 7.6%.MRAB was colonized from 104 patients, the ratio of colonization is 34.6%.The numbers of patients infected by MRSA is 43, the ratio of infection is 14.3%, the ratio of MRSA positive (colonization/infection) is 33.6%, the ratio of after admission of MRSA positive is 28.2%. The prevalence of MRSA was highest at June and declined after, at same time, the prevalence of MRAB keep higher in old ward and lower in new ward. The detection ratio of nasal fossa was highest and stationary in the patients' specimens. The detection raito of staffs' hand was higher than nasal fossa, MRSA is 8.88% and MRAB is 11.15%. The specimens of environments were identified of MRSA and MRAB, the ratio of bed sheets, handrail of beds and observation tables of nurses' were higher than others.
3) The MRAB resistance status was very seriously, the isolation rate of MRAB was 79.6%, PRAB was37.1%, the isolation rate of patient specimens increased significantly in the new ward and resistance to change with great speed. The resistance to imipenem and minocycline were significantly increased.
4) The contamination of water taps was significantly correlated to MRAB co colonization and infection after admission.
5) The results of the risk factor analysis, Periods of staying in ICU, Intubations, the kind of Surgery( acute or choosing times), Using third-generation cephalosporins, Using second-generation cephalosporins, Using peptidoglycan and Types of antibiotic were correlated to MRSA colonization and MRAB conlonization or infection, In addition, APCHEII score at 24h, type of nutrition, Times of exchanging beds. Surgical trauma, Surgery, Using Quinolone, Using carbapenems, Using semisynthetic penicillin and Using aminoside were correlated to MRAB colonization or infection. Periods of staying in ICU was a common independent risk factor .intubations before admission and Using second-generation cephalosporins were only independent factors of MRSA,but APCHEII score at 24h, Using third-generation cephalosporins. Using peptidoglycan and Surgery were independent factors of MRAB.
6) ICU staying .Duration of intubations after admission, times of Surgery, Using third-generation cephalosporins, peptidoglycan, carbapenems and antibiotic of anti-fungus were correlated to MRSA and MRAB positive after admission, In addition. Times of exchanging beds, types of antibiotics, Quinolone, semisynthetic penicillin and aminoside were only correlated to MRAB. Periods of staying in ICU and mix nutition were independent risk factors to MRSA and MRAB positive after admission, besides. Times of exchanging beds, aminosid and antibiotics of anti-fungus were only independent risk factors to MRAB.
7) contact rate was 3.55 (old ward) and 1.6 (new ward), contact rate of every stuffs was 7.1 (old ward) and 2.7 (new ward), contact between stuffs and environment around patients was 2.4.
8) The value of bs_(MRSA) was 0.179, bs_(MRAB) was 0.154.
9) cohort probability (q) . was close to the positive after admission of multi-resistant bacteria, In November, q was highest, at same time, the prevalence of MRSA and MRAB were lowest , in June ,q was lowest, at same time, the prevalence of MRSA and MRAB were highest
10) In June, the prevalence of MRSA and MRAB after admission was highest,μ_(MRSA) andμ_(MRAB) were lowest, but in November, the prevalence MRSA and MRAB after admission were lowest, two values were in the peak of the new wards and close to positive patients after admission.
11) The trends of ratio curve of Np and Ns were different with the trend of positive patients after admission.
12) The total average compliant rate of hand hygiene is 27.8%. the compliant rate between different objects was no statistical Significance. The compliant rate of before contact patients was highest, 44.9% and incidence rate was also highest, 66.2%. after contact patients and after contact articles related with patients were very low(10.6% and 11.7%).The compliant rate of nurses under all indicators were significantly higher than doctors, the methods of compliant were significant different, the methods of before contact patients was using gloves, after contact patients was using ABHR, the using rate of doctors was significantly higher than nurses. In low-pollution hazards, the compliant rate of contact steriles was highest .44.6%, in high-pollution hazards, the compliant rate of contact faeces and comtaminated by faeces were higner , 84.6% and 76.9%, while the contact with skin , wound, intravenous injection and so on, the compliant rate of hand hygiene were lower ,only 40%.
Conclusion:
Monitoring colonization of patients, stuffs and environment, appropriate isolation to bring positive patients, strengthen the protection of susceptible populations, shorten ICU stay time, reducing the number of transfer bed , reducing intubation and durations, adjusting the medication practices of doctors, in particular, reducing the using of cephalosporins, aminoglycosides and anti-fungal antibiotic, strengthening the promotion and supervision ompliant rate of hand hygiene, providing a reasonable number of stuffs , strict 1:1 of patient to stuffs who took care of patients directly and strengthening of environmental disinfection . Developing a comprehensive infection control measures were effective in reducing the colonization or infections of multiple drug-resistant bacterias.
开展医院感染监测对于控制管理医院感染有着十分重要的意义,主要包括综合性监测和目标性监测,二者各有局限性。而多重耐药菌的动力学研究在目前国际国内研究中仍处于尝试阶段。因此,开展多重耐药菌定植感染目标性结合全面性监测,同期结合传播动力学研究,分析感染控制措施作用,全面研究多重耐药菌定植感染的关键因素,有助于降低医院感染的流行。
本研究选择一所国内大型综合性医院的外科重症监护病房作为目标性监测对象,采用前瞻性设计,开展住院患者、医护人员和环境因素(空气及物品表面等)的综合性监测。以耐甲氧西林金黄色葡萄球菌和多重耐药鲍曼不动杆菌为目标菌群。监测同期开展多重耐药菌传播动力学研究,主要包括:医患接触率,患者与医务人员数量比,阳性患者转出频率及接触中传播机率等;感染控制措施(医护人员的手卫生和医务人员分组)效果研究。利用该病房搬迁事件,深入分析环境因素与多重耐药菌传播的关系。开展多重耐药菌定植感染监测,减少医务人员病房内接触,适当隔离并加快转出阳性携带患者,加强手卫生宣传监督,建议护士与患者1对1分组原则,加强环境消毒,才能有效地减少多重耐药菌医院内定植感染的发生,为医院感染多重病原体监测和传播动力学的进一步深入发展提供研究依据。
Nosocomial infection had became a worldwide major public health problem, patients with high infection and mortality rate were seriously affected the development of medical standards and gived a heavy burden on families and society. As the abuse and misuse of antibiotics was prevalent, and nosocomial infection characteristics of multi-drug resistant pathogens present, treatment was even more difficult, therefore, prevention and control of nosocomial infection prevalence became particularly necessary. ICU was a high incidence of nosocomial infection departments, methicillin-resistant Staphylococcus aureus and multi-drug resistant Acinetobacter baumannii infections were caused by the incidence of nosocomial infection in the first place. Monitoring colonization and infection of MRSA and MRAB in the SICU, related risk factors analysised , combined with the transmission dynamics parameters and status research of infection control measures (hand hygiene of medical personnel) , in-depth analysis of the key factors about the spread of MRSA and MRAB in this SICU, in order to better prevention and control prevalence of multi-resistant nosocomial infection pathogen, filling research gaps, promoted the nosocomial infection epidemiology to the rapid development of new research directions.
Objective:
To monitor the prevalence of meticillin-resistance Staphylococcus aureus (MRSA) and multi-drug-resistance Acinetobacter banmannii(MRAB) , antibiotics resistance status,;to analyze the risk factors of colonization and infection; to analyze the transmission dynamics study of important parameters and medical personnel hand hygiene status, determine the impact key factors of multi-drug-resistant bacteria in ICU.
Methods:
(1)Monitoring the colonization and infection
The inpatients and healthcare workers in a surgical intensive care unit (SICU) were investigated the colonization and infection of MRSA and MRAB. Patients were screened for MRSA or MRAB colonization within the first 48h of admission and once within two days thereafter, with swab samples taken from the anterior nares, forehead, groins, axillae. In the same period, swab samples taken from the anterior nares of health care workers were obtained at least once monthly, and the propotion of contacts resulting in the hands of health care workers were obtained once within two days, they were collected and also served as screening cultures for MRSA and MRAB. Swab samples collected from the environments nearby patients and work section (e.g., handrail of beds, buttons of equipment, bed sheets, bed table, observation tables and books of nurse, water taps, calculators, tables used to fill prescriptions) were obtained once within four days and also served as screening cultures for MRSA and MRAB. Screening swabs and propotion of all respiratory specimens were inoculated on blood plates and then incubated overnight at 37°C.The resemble colonies of MRSA were identified by presence of protein A, fibrinogen receptor, coagulase and CHROMagar Staph aureus(CSA). The resemble colonies of MRAB were identified by the typical colonies on the blood Plate, 42°C growth, the typical colonies on the China-Blue medium , Triple Sugar Iron Agar and Citrate agar ,seven types of antibiotic susceptibility test (three or more drug-resistant).The seven types of antibiotic is Cefuroxime , Cefepime . Cefotaxime , Imipenem , Amikacin , Minocycline and Levofloxacin .
Risk factor(e,g, age, sex, underlying conditions, reason for admission, urgency of admission, previous hospitalization and origin of referral, immediate unit within the hospital before the ICU, time and place of intubations, Acute Physiology and Chronic Health Evaluation (APACHE) II score at 24h, Glasgow coma score, number of organs that would fail without mechanical or pharmacologic support, duration and type of intubations) analysis included univariate and multivariate approaches.
(2) Investigation of parameters describing strength of transmission
The parameters used were based on daily data collection and direct observation of staff-patient contact patterns. Observed parameters for each monthly interval were admission and discharge rates of colonized and noncolonized patients and average staff numbers. The proportion of staff who did not contribute to transmission, which was equivalent to the cohorting probability, q, the staff-patient contact rate, the probability of hand washing/disinfection, the probabilities of transmission from patient to staff were obtained from investigantion. The possible role of environmentalfactors was analyzed.
Results:
1) ICU moved to a new environment at July 15th 2008, the environment, management and staffs were changed largely.
2) From April 2008 to January 2009.301 patients (admission after 48h) were treated in the ICU during the investigation period. MRSA was colonized from 39 patients, the ratio of colonization is 13.0%.The numbers of patients infected by MRSA is 11, the ratio of infection is 3.7%, the ratio of MRSA positive (colonization/infection) is 13.6%, the ratio of after admission of MRSA positive is 7.6%.MRAB was colonized from 104 patients, the ratio of colonization is 34.6%.The numbers of patients infected by MRSA is 43, the ratio of infection is 14.3%, the ratio of MRSA positive (colonization/infection) is 33.6%, the ratio of after admission of MRSA positive is 28.2%. The prevalence of MRSA was highest at June and declined after, at same time, the prevalence of MRAB keep higher in old ward and lower in new ward. The detection ratio of nasal fossa was highest and stationary in the patients' specimens. The detection raito of staffs' hand was higher than nasal fossa, MRSA is 8.88% and MRAB is 11.15%. The specimens of environments were identified of MRSA and MRAB, the ratio of bed sheets, handrail of beds and observation tables of nurses' were higher than others.
3) The MRAB resistance status was very seriously, the isolation rate of MRAB was 79.6%, PRAB was37.1%, the isolation rate of patient specimens increased significantly in the new ward and resistance to change with great speed. The resistance to imipenem and minocycline were significantly increased.
4) The contamination of water taps was significantly correlated to MRAB co colonization and infection after admission.
5) The results of the risk factor analysis, Periods of staying in ICU, Intubations, the kind of Surgery( acute or choosing times), Using third-generation cephalosporins, Using second-generation cephalosporins, Using peptidoglycan and Types of antibiotic were correlated to MRSA colonization and MRAB conlonization or infection, In addition, APCHEII score at 24h, type of nutrition, Times of exchanging beds. Surgical trauma, Surgery, Using Quinolone, Using carbapenems, Using semisynthetic penicillin and Using aminoside were correlated to MRAB colonization or infection. Periods of staying in ICU was a common independent risk factor .intubations before admission and Using second-generation cephalosporins were only independent factors of MRSA,but APCHEII score at 24h, Using third-generation cephalosporins. Using peptidoglycan and Surgery were independent factors of MRAB.
6) ICU staying .Duration of intubations after admission, times of Surgery, Using third-generation cephalosporins, peptidoglycan, carbapenems and antibiotic of anti-fungus were correlated to MRSA and MRAB positive after admission, In addition. Times of exchanging beds, types of antibiotics, Quinolone, semisynthetic penicillin and aminoside were only correlated to MRAB. Periods of staying in ICU and mix nutition were independent risk factors to MRSA and MRAB positive after admission, besides. Times of exchanging beds, aminosid and antibiotics of anti-fungus were only independent risk factors to MRAB.
7) contact rate was 3.55 (old ward) and 1.6 (new ward), contact rate of every stuffs was 7.1 (old ward) and 2.7 (new ward), contact between stuffs and environment around patients was 2.4.
8) The value of bs_(MRSA) was 0.179, bs_(MRAB) was 0.154.
9) cohort probability (q) . was close to the positive after admission of multi-resistant bacteria, In November, q was highest, at same time, the prevalence of MRSA and MRAB were lowest , in June ,q was lowest, at same time, the prevalence of MRSA and MRAB were highest
10) In June, the prevalence of MRSA and MRAB after admission was highest,μ_(MRSA) andμ_(MRAB) were lowest, but in November, the prevalence MRSA and MRAB after admission were lowest, two values were in the peak of the new wards and close to positive patients after admission.
11) The trends of ratio curve of Np and Ns were different with the trend of positive patients after admission.
12) The total average compliant rate of hand hygiene is 27.8%. the compliant rate between different objects was no statistical Significance. The compliant rate of before contact patients was highest, 44.9% and incidence rate was also highest, 66.2%. after contact patients and after contact articles related with patients were very low(10.6% and 11.7%).The compliant rate of nurses under all indicators were significantly higher than doctors, the methods of compliant were significant different, the methods of before contact patients was using gloves, after contact patients was using ABHR, the using rate of doctors was significantly higher than nurses. In low-pollution hazards, the compliant rate of contact steriles was highest .44.6%, in high-pollution hazards, the compliant rate of contact faeces and comtaminated by faeces were higner , 84.6% and 76.9%, while the contact with skin , wound, intravenous injection and so on, the compliant rate of hand hygiene were lower ,only 40%.
Conclusion:
Monitoring colonization of patients, stuffs and environment, appropriate isolation to bring positive patients, strengthen the protection of susceptible populations, shorten ICU stay time, reducing the number of transfer bed , reducing intubation and durations, adjusting the medication practices of doctors, in particular, reducing the using of cephalosporins, aminoglycosides and anti-fungal antibiotic, strengthening the promotion and supervision ompliant rate of hand hygiene, providing a reasonable number of stuffs , strict 1:1 of patient to stuffs who took care of patients directly and strengthening of environmental disinfection . Developing a comprehensive infection control measures were effective in reducing the colonization or infections of multiple drug-resistant bacterias.
引文
[1]http://www.cdc.gov/Partners/Archive/PartnershipMatters/Correction:A Message from the Editor May 30,2008.
[2]Alicia I,Hidron MD,Jonathan R,et al.Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections:Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention,2006-2007[J].Infection control and hospital epidemiology.2008,29(11):996-1011.
[3]CDC.National Nosocomial Infections Surveillance(NNIS) system report,data summary from January 1990-May 1999,issued June 1999[J].Am J Infect Control 1999;27:520-532.
[4]CDC.National Nosocomial Infections Surveillance(NNIS) system report,data summary from October 1986-April 1998.,issued June 1998.Available at:http://www.cdc.gov/ncidod/dhqp/pdf/nnis/sar98net.PDF.Accessed at December 12,2007.
[5]吴安华,任南,文细毛等.全国医院感染监控网1998-1999年监控资料分析[J].中华医院感染学杂志,2000,10(6):401-403.
[6]刘晶晶,袁洪.医院感染的发展状况[J].实用预防医学杂志,2004.11(5):1073.
[7]Askarian M,Gooran NR.National nosocomial infection surveillance system-based study in Iran:additional hospital stay attributable to nosocomial infection[J].Am J Infect Control,2003,31(8):465-468.
[8]Singh AK,Sen MR,Anupurba S,et al.Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU[J].J Conllnun Dis,2002,34(4):257-263.
[9]杨海燕,方静.ICU细菌流行病学调查及护理对策[J].齐齐哈尔医学院学报.2003.24(3):286-288.
[10]张凤运,梁艳芳.SARS流行期间医院感染管理的重点[J].中华医院感染学杂志.2004,14(5):557.
[11]李六亿,章友康.从SARS防治反思我国医院感染管理工作[J].中国医院,2003,7(9):39-42.
[12]韩哲臣.从SARS流行浅谈医院感染管理工作[J].中华医院感染学杂志,2004,14(7):791-793.
[13]王建斌,吴俊霞,张素萍等.后ASRS时代医院感染管理的发展[J].中华医院感染学杂志,2004,14(4):430-432.
[14]张玉华.由SARS引发的对我国医疗卫生工作中三个问题的思考[J].中华医院管理杂志,2003,19(7):385-387.
[15]王发强,陈金宏.防治“非典”工作中实现“院内零感染”的做法[J].中国医院管理杂志,2003,23(7):13-14.
[16]Kohn L,Corrigan J,Donaldson M.To err is human:building a safer health system.Washington,DC[J]:Institute of Medicine,National Academy Press,1999.
[17]Jarvis WR.Selected aspects of the socioeconomic impact of nosocomial infections:morbidity,mortality,cost,and prevention[J].Infect Control HosP Epidemiol 1996,17(8):552-557.
[18]Murray PR,Baron EJ,Pfaller MA,et al.Mannul of clinidal microbiology.7th ed.Washington[J]:ASM Press,1999:107-109.
[19]Levy SB.Multidrug resistance-a sign of the times[J].N Engl J Med,1998,338(19):1376-1378.
[20]于巍。慎用抗生素[J].中国科技纵横,2004,(2):33.
[21]Klevens RM,Edwards JR,Tenover FC,McDonald LC,Horan T,Gaynes R;National Nosocomial Infections Surveillance System.Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals,1992-2003[J].Clin Infect Dis 2006;42:389-391.
[22]National Nosocomial Infections Surveillance(NNIS) system report,data summary from January 1992 through June 2004,issued October 2004[M].Am J Infect Control.2004;32:470-485.
[23]马绪荣,苏德模.药品微生物学检验手册[M].北京:科学出版社.2003:142-145.
[24]Rohrer S,Tschierske M,Zbinden R,et al.Imp roved methods for detection of methicillin-resistant staphylococcus aureus[J].Eur J Clin Microbiol Infect Dis,2001,20(4):267-270.
[25]National Committee for Clinical Labcrtory Standard for Performance Standards for Antimicrobioal Susceptibility Testing[M].Fifth Informational Supplement 2005.M1002S15 Vol.25 No.1.
[26]Fang H,Hedin G.Rapid screening and identification of methicillin-resistant Staphylococcus aureus from clinical samples by selectivebroth and real-time PCR assay[J].J.Clin.Microbiol,2003,41:2894-2899.
[27]Reischl U,Linde HJ,Metz M,et al.Rapid identification of methicillin-resistant Staphylococcus aureus and simultaneous species confirmation using real-time fluorescence PCR[J].J Clin Microbiol,20008:2429-2433.
[28]Killgore GE,Holloway B,et al.A 5- nuclease PCR(TaqMan) high-throughput assay for detection of the mecA gene in staphylococci[J].J Clin Microbiol,2000,38:2516-2519.
[29]Nakatomi Y,Sugiyanma J.A rapid latex agglutination assay for the detection of penicillin-binding proteina[J].Microbial,1998,41(11):739-743.
[30]Van Griethuysen A,Pouw M,van Leeuwen N:et al.Rapid Slide Latex Agglutination Test for Detection of Methicillin Resistance in Staphylococcus aureus[J].Journal of Clinical Microbiology,1999,9(37):2789-2792.
[31]Wisplingoff H,Bischoff T,Tallent SM,et al.Nosocomial bloodstream infection in US hospital analysis of 4,179 cases from a prospective nationwide surveillance study[J].Clin Infect dis,2004,39:309-317.
[32]John Conly.Antimicrobial resistance in Canada[J].CMAJ 2002,167:885-891.
[33]赖晓全.重症监护病房的MRSA[J].实用医学杂志.2004,10(20):1191-1192.
[34]Lim TT,Coombs GW,Grubb WB,et al.Genetic organization of mecA and mecA regulatory genes in epidemic methicillin-resistantst Saphylococcus aureus from Australia and England[J].J Antimrobial Chemotherapy,2002,50:819-824.
[35]Satoshi Hori,Meticillin-resistant Staphylococcus aureus Japan[J].Lancet Infect Dis 2005,5:657-658.
[36]Monina R,Melissa A.Joelle N,et al.Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States[J].JAMA.2007,2(8):1763-1771.
[37]王辉,孙宏莉,陈民钧等.2005年我国五家教学医院革兰阳性球菌耐药监测研究[J].中华检验医学杂志.2006.10(29):873-877.
[38]李家泰,李耘.王进.中国医院和社区获得性感染革兰阳性球菌耐药性监测研究[J].中华医学杂志,2003,83(5):365-374.
[39]李家泰,齐慧敏,李耘.2002-2003年中国医院和社区获得性感染革兰阳性细菌耐药监测研究[J].中华检验医学杂志,2005.28:254-265.
[40]任南,文细毛,吴安华.全国医院感染监控网对医院内金黄色葡萄球菌感染及耐药性监测报告[J].中国医学工程.2007,15:425-427.
[41]Holmes.A,M.Ganner,S.Mcguane,et al.Staphylococcus aureus isolates carring Panton Valentine Leucocidin genes in England and Wales:frequency,characterization and association with clinical disease.2005,43:2384-2390.
[42]John J F,Greishop TJ,Atkins LM,et al.Widespread colonization of personnel at a veterans affair medical center by methicillin resistant,coagulase-negative staphylococcus[J].Clin Infect Dis,1993,17(3):380
[43]Onorato M,Borucki MJ,Baillargeon G,et al.Risk factors for colonization or infectiondue to methicillin-resistant Staphylococcus aureus in HIV-positive patients:a retrospectivecase-control study[J].Infect Control Hop Epidemiol,1999,20(1):26-30
[44]Kaye KS,Fraimow HS,Abrutym E Pathogens resistant to antimicrobial agents-epidemiology,molecular mechanisms,and clinical management[J].Infect Dis Clin North Am,2000,14(2):293-319
[45]DANCER S J.Considering t he int roduction of universal MRSA screening[J].J Hos Inf ect,2008,69:315-320.
[46]KAZAKOVA SV,HAGEMAN JC,MATAVA M,et al.A clone of methicillin resistant S taphylococcus aureus among p rofessional football players[J].N Engl J Med,2005,352(5):468-475.
[47]DELANEY JA,SCHNEIDER L INDNER V,BRASSARD P,et al.Mortality after infection with methicillin resistant S taphylococcus aureus(MRSA) diagnosed in the community[J].BMCMed,2008,6:2.
[48]王进.肖永红.Mohnarin 2006-2007年度报告:革兰阳性菌耐药监测结果[J]中国抗生素杂志,2008.10,33(10):592-596
[49]李家泰,W einstein AJ,杨敏,等.中国细菌耐药监测研究[J].中华医学杂志.2001,81(1):8-16
[50]王进,肖永红,李耘.2004-2005年度全国革兰阳性菌耐药监测(Mohnarin)[J].中华传染病杂志,2008,26(5):268-274.
[51]Centers for Disease Control and Prevention(CDC).Staphylococcus aureus resistant to vancomycin2United States,2002[J].MM WR M orbM orta1W kly Rep,2002,51(26):565-567.
[52]SIEVERT DM,RUDR IK JT,PATEL JB,et al.Vancomycin resistant Staphylococcus aureus in the United States,2002-2006[J].Clin Infect D is,2008, 46(5):668-674.
[53]马越,陈鸿波,姚蕾等.耐甲氧西林金黄色葡萄球菌对万古霉素敏感性的变迁[J].中华内科杂志,2002.41(1):31-33.
[54]Walsh C.Molecular mechanisms that confer antibacterial drug resistance[J].Nature,2000,17(406):775-781.
[55]Hawkey PM.The origins and molecular basis of antibiotic resistance[J].British Medical Journal,1998,5(7159):657-660.
[56]王德海,程国富,胡薛英.耐甲氧西林金黄色葡萄球菌的耐药机制分析[J].中国畜牧兽医,2007,6(34):85-87.
[57]Lim TT,Coombs GW,Grubb WB.Genetic organization of mecA and mecA regulatory genes in epidemic methicillin resistant Staphylococcus aureus from Australia and England[J].J Antimicrob Chemother.2002.50(6):819-824.
[58]Hackbarth CJ,Chamber HF.BlaI and blaR1 regulate β-lactamaseand PBP2a production in methicillin-resistant Staphylococcus aureus[J].Antimicrob Agents Chemother.1993,37:1144-1149.
[59]De Lencastre H.Tomasz A.Reassessment of the number of auxiliary genes essential for expression of high-level methicillin-resistance in Staphylococcus aureus[J].Antimicrob Agents chemother.1994,38(11):2590.
[60]朱中勇.实用医学检验第一版[M].北京:人民军医出版社.1992;658-660
[61]JawadA,SeefirtH,SnellnigA,et al.Suvrival of Acineotbacetr buamannii on dry surfaces:comparisor of outbreak and sporadic isolates[J].J clin Microbiol,1998Jul:36(7):1938-1941.
[62]刘明德.三所医院内不动杆菌的分离及理化因子敏感性研究[J].医院感染与管理杂志,1990:5(1):22.
[63]Berg DE,Hershow RC.Ramirez CA,et al.Control of nosocomial infections in an intensive care unit in Guatemala City[J].Clin Infect Dis.1995,21:588-593.
[64]Wisplinghoff H,Edmond MB,PfallerMA,et al.Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals:clinical features,molecular epidemiology,and antimicrobial susceptibility[J].Clin Infect Dis.2000.31:690-697.
[65]李秀云,徐敏.鲍曼不动杆菌医院感染分析及其防治对策[J].护理学杂志,2004;19(11):70-72.
[66]吴安华,文细毛,任南等.全国医院感染监测网医院感染呼吸道,泌尿道,胃肠道感染病原学及其变迁[J].中国感染控制杂志,2003;2(4):252-255.
[67]任利珍,张翊.革兰阴性杆菌在医院感染的检测及耐药性分析.中华医院感染学杂志[J].2003,13(10):964-965.
[68]李景云,马越,陈鸿波等.1997-2001年不动杆菌属临床分离株分布特点和耐药性分析[J].中国临床药理学杂志.2002,18(6):421-424.
[69]Merino LA,Ronconi MC,Marin M,et al.Non-fermenting bacilli:distribution in clinical specimens and antimicrobial susceptibility[J].Rev Latinoam Microbiol.1999,41(4):279-284.
[70]俞树荣.微生物学和微生物学检验第二版[M].北京.人民卫生出版社.1999.
[71]Joshi SG,Ghole VS,Niphadkar KB.Neonatal gram-negative baceteremia[J].Indian J Pediatr.2000;67(1):27-32.
[72]Lolans K,Rice TW,Munoz-Price LS,et al.Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40[J].Antimicrob Agents Chemother 2006;50:2941-2945.
[73]Manikal VM,Landman D,Saurina G,et al.Endemic carbapenem-resistant Acinetobacter species in Brooklyn,New York:citywide prevalence,interinstitutional spread,and relation to antibiotic usage[J].Clin Infect Dis.2000,3:101-106.
[74]Naas T,Coignard B,Carbonne A,et al.VEB-1 extended-spectrum betalactamaseproducing Acinetobacter baumannii,France[J].Emerg Infect Dis.2006;12:1214-1222.
[75]Coelho JM,Turton JF,Kaufmann ME,et al.Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and Southeast England[J].J Clin Microbiol.2006:44:3623-3627.
[76]Iregbu KC,Ogunsola FT,Odugbemi TO.Infections caused by Acinetobaceter species and their susceptibility to 14 antibiotics in Lagos University Teaching Hospital,Lagos[J].West Afr J Med.2002:21(3):226-229.
[77]Mittal N,Nair D,Gupta N,et al.Outbreak of Acinetobacter spp.Septicemia in a neonatal ICU[J].Southeast Asian J Top Med Public Health.2003;34(2):365-366.
[78]Tejada AA,Bello DS,Chacon VE,et al.Risk factors for nosocomial pneumonia in critically ill trauma patients[J].Crit Care Med.2001,29:304-309.
[79]刘丁,陈萍,陈伟等.鲍曼不动杆菌医院感染的危险因素及基因分型研究[J].中华流行病学杂志.2003,24(2):140-142.
[80]Bergogne-Berezin EJ,Towner K.Acinetobacter spp.as nosocomial pathogens:microbiological,clinical,and epidemiological features[J].Clin Microbiol Rev,1996,9:148-165.
[81]Husni RN,Goldstein LS,Arroliga AC.et al.Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients[J].Chest,1999,115:1378-1382.
[82]Baraibar J,Correa H,Mariscal D,et al.Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia[J].Chest,1997,112:1050-1054.
[83]Sunenshine RA,Wright MO,Maragakis LL.et al.Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization[J].Emerg Infect Dis 2007;13:97-103.
[84]Garnacho J,Sole-Violan J,Sa-Borges M,et al.Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients:a matched cohort study[J].Crit Care Med 2003;31:2478-2482.
[85]胡庆丰,杨广宇,吕火祥等.重症监护病房不动杆菌感染的流行和耐药性分析[J].中国微生态学杂志,2006.18(2):132-133.
[86]徐秀华,李顺强.不动杆菌感染及耐药性的研究[J].中华医学杂志,2000;24(3):116-118.
[87]Bayuga S,Zeana C,Sahni J,et al.Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients:the icegerg phenomenon again[J].Heart Cnag.2002;31(5):382-390.
[88]陶映,陈文光.章泽豹.重症监护病房鲍氏不动杆菌暴发流行控制[J].中华医院感染学杂志.2004.14(10):1183.
[89]Pillay T,Pillay DG,Adhikari M,et al.An outbreak of neonatal infection with Acinetobacter linked to contaminated suction catheters[J].J Hosp Infect,1999;43(4):299-304.
[90]高丽芹,苏吉星.鲍曼不动杆菌致会阴侧切术后切口感染[J].中华医院感染学杂志.2003:13(5):462.
[91]Onarheim H,Hovivik T,Harthug S,et al.Outbreak of multi-resistant Acinetobacter baumannii infection[J].Tidsskr Nor Laegeforen.2000;120(9):1028-1033.
[92]Mcdonald LC,Banerjee SN,Jarvis WR.Seasonal variation of Acinetobacter infetions:1987-1996[J].Clin Inefect Dis.1999;29(5):1133-1137.
[93]Smith PW.Seasonal incidence of Acinetobacter infection[J].J Infect Dis 1979;140:275-276.
[94]Chen MZ,Hsueh PR,Lee LN,et al.Severe communityacquired pneumonia due to Acinetobacter baumannii[J].Chest 2001;120:1072-1077.
[95]Anstey NM,Currie BJ,Hassell M,et al.Communityacquired bacteremic Acinetobacter pneumonia in tropical Australia is caused by diverse strains of Acinetobacter baumannii,with carriage in the throat in at-risk goups.[J]J Clin Microbiol 2002;40:685-686.
[96]Leung WS,Chu CM,Tsang KY.et al.Fulminant communityacquired Acinetobacter baumannii pneumonia as a distinct clinical syndrome[J].Chest 2006;129:102-109.
[97]Tong MJ.Septic complications of war wounds[J].JAMA 1972;219:1044-1047.
[98]Hawley JS,Murray CK,Griffith ME,et al.Susceptibility of acinetobacter strains isolated from deployed U.S military personnel[J].Antimicrob Agents Chemother,2007;51:376-378.
[99]Griffith ME,Lazarus DR,Mann PB,et al.Acinetobacter skin carriage among US army soldiers deployed in Iraq[J].Infect Control Hosp Epidemiol 2007;28:720-722.
[100]Acinetobacter baumannii infections among patients at military medical facilities treating injured U.S.service members,2002-2004[J].MMWR Morb Mortal Wkly Rep 2004:53:1063-1066.
[101]Maegele M,Gregor S,Steinhausen E,et al.The long-distance tertiary air transfer and care of tsunami victims:injury pattern and microbiological and psychological aspects[J].Crit Care Med 2005;33:1136-1140.
[102]Carey RB,Banerjee SN,Srinivasan A.Multidrug-resistant acinetobacter infections,1995-2004[J].Presented at the 46th Interscience Conference on Antimicrobial Agents and Chemotherapy San Francisco,2006,September 27-30.
[103]王露霞,石凌波,徐德兴等.应用纸片扩散法与梯度浓度法测定鲍曼不动杆菌的耐药性[J].第一军医大学学报,2003;23(5):469-471.
[104]Wang H,Chen MJ,Changes of anti-microbial resistance among nonfermenting gram-negative bacilli isolated from intensive care units from 1994 to 2001 in China[J].Zhong Hua Yi Xue Za Zhi.2003;83(5);385-389.
[105]简翠,叶涛,张蓓等.Mohnarin 2006-2007年度报告:中南地区细菌耐药监测[J].中国抗生素杂志.2008:33(10):608-615.
[106]胡云建.Mohnarin 2006-2007年度报告:非发酵革兰阴性杆菌耐药性监测[J].中国抗生素杂志.2008:33(10):597-601.
[107]Giamarellos-Bourboulis E J,Xirouchaki E,Giamarellou H.Interaction of colistin and rifampin on multidrug-resistant A cinetobacter baumannii[J].Dignostic Microbiol and Infect Dis.2001,40:117-120.
[108]Urban C,Mariano N,Rahal JJ.Polymyxin-resistant Acinetobacter baumannii clinical isolate suscep tible to recombinant BPI and cecrop in P1[J].Antim icrob Agents Chem other,2001;45:994-995.
[109]黄小群.ICU医护人员MRSA带菌状况调查研究[J].中国医疗前沿.2008,3(23):109-110.
[110]张春环.ICU鲍曼不动杆菌感染流行情况调查分析[J].哈尔滨医药.2007,27(3):10-11.
[111]同俏静,庄一渝,林洁.鲍曼不动杆菌致下呼吸道感染暴发的调查及干预[J].中华医院管理杂志.2007,23(12):822-824.
[112]戴海,吕爱云,冯海荣.ICU铜绿假单胞菌感染暴发流行的调查[J].江西医学检验.2005,23(3):219-220.
[113]Tenover F.Arbeir R,Goering R.How to select and interpret molecular strain typing methods for epidemiological studies of bacteril infections:a review for healthcare epidemiologists[J].Infect Control Hosp Epidemiol,1997.18:426-439.
[114]A.Deplano,O.Dems,L.Poirel.Molecular Characterization of an Epidemic Clone of Panan tibiofic-Resistant Pseudomonas aeruginosa[J].J Clin Mic,2005,43(3):1198-1204.
[115]郭述良,何礼贤,张磊,等.机械通气患者嗜麦芽窄食单胞菌暴发感染分子流行病学研究[J].中华结核和呼吸杂志志,2005.28(5):310-314.
[116]盂玉芬,韩黎,吴桂芝等.烧伤病房MRSA医院感染暴发的PFGE分型研究[J].微生物学通报,2006,(3):65-69.
[117]Hilmar Wisplinghoff,Birgitta Ewertz,Susanne Wisplinghoff,et al.Molecular Evolution of Methicillin-Resistant Staphylococcus aureus in the Metropolitan Area of Cologne,Germany,from 1984-1998[J].Journal of Clinical Microbiology,2005,43(11):5455-5451.
[118]Scanvic,A.,Denic,L.,Gaillon,S.,et al.Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage[J].Clin.Infect.Dis.2001,32(10),1393-1398.
[119]Sanford M.D,Widmer A.F,Bale M.J,et al.Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus[J].Clin.Infect.Dis.1994,19:1123-1128.
[120]Hyman JM,Jia Li,Stanley EA.The differential infectivity and staged progression models for the transmission of HIV[J].J Mathe-matical Biosciences,1999,155:77-91.
[121]Cooper BS,Medley GF,Scott GM.Preliminary analysis of the transmission dynamics of nosocomial infections:stochastic and management effects[J].J Hosp Infect 1999,43:131-147.
[122]Austin DJ,Bonten MJM,Weinstein RA,et al.Vancomycin-resistant enterococci in intensive-care hospital settings:transmission dynamics,persistence,and the impact of infection control programs[J].Proc Natl Acad Sci USA 1999,96:6908-6913.
[123]张小容.医院工作人员医院感染的原因及预防对策[J].中华医院感染学杂志,2003,13(3):298-300.
[124]McBryde E,Pettitt A,Mc Elwain D.A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit:Predicting the impact of interventions[J].Journal of Theoretical Biology 2007,245:470-481.
[125]Grundmann H,Hori S,Winter B,et al.Risk factor for the transmission of methicillin-resistant Staphylococus aureus in an adult intensive care unit:fitting a model to the data[J].J Infect Dis 2002,185:481-488.
[126]Julia S,Garner,Favero MS.Guideline for Handwashing and Hospital Environmental Control.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116al.ht
[127]Larson EL.AIPC Guideline for Handwashing and Hand antisepsis in Health Care Settings.Am J Infect Control.1995,23:251-69.
[128]中华人民共和国卫生部.医院感染诊断标准(试行)[S].北京:中华人民共和国卫生部,2001.
[129]中华人民共和国卫生部,消毒技术规范2002年版[S],北京:中华人民共和国卫生部,2002
[130]Performance Standards for Antimicrobial Susceptibility Testing;Eingteenth[J].Clincical and Laboratory Standards Institute[S].USA:2008
[131]邹宝波,程科萍,何琅等,某院14年医院感染发病率变迁[J].中国感染控制杂志,2005,4(2):171-172.
[132]许淑琴,俞碗如,汤丽娟等.10245例住院患者医院感染分析[J].浙江预防医学,2005,17(8):33.
[133]文细毛,任南,徐秀华等.全国医院感染监控网医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2002,(4):4-7.
[134]朱华芳,王惟,徐晓光.326株病原菌及药敏分析[J].检验医学与临床,2007,4(6):576-577.
[135]陈根娣.44707例住院病例医院感染调查分析[J].临床荟萃.2001,16(8):347-348.
[136]杨月华.医院感染病原菌分布及药敏分析[J].职业与健康.2007.23(8):666-667
[137]柳霞,潜江.ICU院内感染常见致病菌的统计分析[J].当代医学.2009,15(22):21.
[138]张亚莉,马骊.耿穗娜等.医务人员与住院患者鼻前庭携带金黄色葡萄球菌的研究[J].中华医院感染学杂志,2007,17(3):263-266.
[139]Kepler A.Davis,Justin J.Stewart,et al.Methicillin-resistant Staphylococcus aureus(MRSA) nare colonization at Hospital admission and its effect on subsequent MRSA infection[J].Clinical Infectious Diseases,2004,39(6):776-782.
[140]Jarvis WR,Schlosser J,Chinn RY.et al.National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities,2006[J].Am J Infect Control.2007 Dec;35(10):631-637.
[141]Virginie Morange-Saussier,Bruno Giraudeau,Nathalie van der Mee,et al.Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in Vascular Surgery[J].Ann Vasc Surg,2006,20(6):767-772.
[142]Maite Garrouste-Orgeas,Jean-Francois Timsit,Hatem Kallel,et al.Colonization with methicillin-resistant staphylococcus Aureus in ICU patients:morbidity,mortality,and glycopeptide use[J].Infection Control and Hospital Epidemiology,2001,22(11):687-692
[143]Martin D,Ciseros J,Becerril B,et al.Comparison of Repetitive Extragenic palindromic sequence-based PCR method and clinical and microbiological methods for determining strain sources in cases of nosocomial infection Acinettobacter baumannii Bacteremia[J].Journal of Clinical Microbiology.2002;40(12):4571-4575.
[144]McDonald LC,Banerjee SN,Jarvis WR.Seasonal variation of Acinetobacter infections:1987-1996[J].Clin Infect Dis.1999;29(5):1133-1137.
[145]Pedtachaiw.Nosoeonlial Pneurnoulania new bomni tensvieeaer unit[J].J med Assoe Thai,2000:83(4):292-397.
[146]Kuo,L.C,Yu,C.J,Kuo,M.L,et al.Antimicrobial resistance of bacterial isolateds from respiratory care wards in Taiwan:a horizontal surveillance study[J].Int.J.Antimicrob.Agents,31,420-426.
[147]Stephanie J DancerImportance of the environment in meticillin- resistant Staphylococcus aureus acquisition:the case for hospital cleaning.Lancent.2007,http://infection.thelancent.com.October 31,2007.
[148]赵伟英,丁亚娣.邓克勤.ICU鲍曼不动杆菌感染的危险因素分析与护理对策[J].中国实用护理杂志.2007,23(7):59-60.
[149]赖晓全,涂敏.重症监护病房耐甲氧西林金黄色葡萄球菌感染的调查[J].中华传染病杂志,2005.23(4):275-277.
[150]魏全珍,刘丽华,张惠珍等.医务人员患者及陪护、环境MRSA带菌状况调查研究[J].中国实用医药,2008.3(9):15-16.
[151]尚少梅等.医院感染与洗手[J].中华医院感染学杂志2001,11(1):78-80.
[152]魏全珍,张惠珍,刘丽华.烧伤病区患者刨面MRSA医院感染流行的预防与控制[J].中华医院感染学杂志,2007.17(7):816-818.
[153]徐丽英,朱美珍,刘彩霞等.多重耐药鲍曼不动杆菌医院感染的暴发和控制[J].浙江中西医结合杂志.2007,17(5):325-326
[154]陈桂桃.病房条件,周围环境与医院感染的关系分析[J].Chinese MedicaI Research&Clinical.2006,4(5):88
[155]Stephanie J.Dancer.Impotance of the environment in meticillin-resistant Stahpylococcus aureus acquisition:the case for hospital cleaning.http//:infection.the lancet.com,2007:October 31.
[156]Oie S,Hosokawa I,Kamiya A.Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus[J].J Hosp Infect 2002;51:140-143.
[157]王瑶,徐春英.2004-2005年中国CHINET鲍曼不动杆菌耐药性分析[J].中国感染与化疗杂志.2007.7(4):279-282.
[158]王辉.陈民钧.1994-2001年中国重症监护病房非发酵糖菌的耐药变迁[J].中华医学杂志.2003.53(5):253-390.
[159]王辉,陈民钧,倪语星等.2003-2004年中国十家教学医院革兰阴性杆菌的耐药分析fJ].中华检验医学杂志,2005.28(12):1295-1303.
[160]应易高,徐晓雯,徐兆余.鲍曼不动杆菌对抗生素的耐药性监测.同济大学学报(医学版).2007,28(4):80-84
[161]Paton R,MilesRS,Ruiz J,et al.AR I - 1:β - lactamase - mediated imipenem resistance in Acinetobacter baumannii[J].Int J Antim icrob Agents,1993;2:81- 88.
[162]Huys G,CnockaertM,VaneechoutteM,et al.Distribution of tetracycline resistance genes in genotyp ically related and unrelated multiresistant Acinetobacter baum annii strains from different European hospitals[J].ResM icrobiol,2005;156:348-355.
[163]Ribera A,Ruiz J,Vila J.Presence of the TetM determinant in a clinical isolate ofAcinetobacter baumannii[J].Antim icrob Agents Chem other.2003:47:2310-2312.
[164]宋逸萍.鲍曼不动杆菌在重症监护病房的感染及耐药性分析[J].检验医学与临床.2007.4(5):460-461.
[165]江涛,罗永艾.医院获得性鲍曼不动杆菌肺炎的临床调查[J].中华医院感染学杂志,2002,12(4):265-267.
[166]韩雪玲,胡淑芳.华梅等.颅脑外科院内感染经济损失病例调查分析说明[J].实用医技杂志.2006,9:124-126.
[167]陈萍,刘丁,陈伟.鲍曼不动杆菌医院感染调查及其危险因素探讨[J].中国现 代医学.2003,13(4):59-61
[168]Fukuda M,Tanaka H,Kajiwara Y,et al.High-risk populations for nasal carriage of methicillin-resistant Staphylococcus aureus[J].J Infect Chemother,2004,10(3):189-191.
[169]Jernigan,J.A.,A.L.Pullen,et al.Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission[J].Infect Control Hosp Epidemiol,2003,24(6):409-414.
[170]文清泉,岳剑虹.术前碘伏消毒口、鼻腔经鼻气管插管对下呼吸道感染的影响[J].中华医院感染学杂志,2007,17(6):694-695.
[171]周素静,雷俊香,王向阳.神经内科下呼吸道感染危险因素分析[J].中华医院感染学杂志,2007,17(1):38-39.
[172]Meyer E.,Jonas D.,Schwab F.,et al.Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units(SARI)[J].Infection 2003;31(4):208-15.
[173]Rodriguez,Hernandez MJ,Pachon J,Pichardo C,et al.Imipenem.doxycycline and amikacin in monotherapy and in combination in Acinetobacter baumannii experimental pneumonia[J].J Antimicrob Chemother,2000;45(4):493-501.
[174]Kevin Kuzu,RN;Fadime ozer,RN;Semara Aydemir,RN,et al.Compliance with hand hygiene and glove uwe in a university-affiliated hospital[J].Infection control and hospital epidemiology.2005,26(3):312-315.
[175]韩黎,朱士俊,郭燕红等.中国医务人员执行手卫生的现状调查[J].中华医院感染学杂志.2006.16(2):140-142.
[176]冯喆,周待春,孙立英.医护人员手卫生的依从率现状调查与相关影响因素分析[J].中国消毒学杂志.2008.25(3):278-280.
[177]邱方诚,王崇玉.医护人员洗手后葡萄球菌的调查[J].中华医院感染学杂志.2005.15(3):300-301
[178]Torres-Viera C,Dembry LM.Approaches to vancomycin-resistant enterococci[J].Curr Opin Infect Dis.2004,17(6):541-547.
[179]韩黎,郭燕红,朱士俊等.医务人员接触患者后手卫生执行情况的调查分析[J].中华医院管理杂志.2006,22(4):230-232.
[2]Alicia I,Hidron MD,Jonathan R,et al.Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections:Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention,2006-2007[J].Infection control and hospital epidemiology.2008,29(11):996-1011.
[3]CDC.National Nosocomial Infections Surveillance(NNIS) system report,data summary from January 1990-May 1999,issued June 1999[J].Am J Infect Control 1999;27:520-532.
[4]CDC.National Nosocomial Infections Surveillance(NNIS) system report,data summary from October 1986-April 1998.,issued June 1998.Available at:http://www.cdc.gov/ncidod/dhqp/pdf/nnis/sar98net.PDF.Accessed at December 12,2007.
[5]吴安华,任南,文细毛等.全国医院感染监控网1998-1999年监控资料分析[J].中华医院感染学杂志,2000,10(6):401-403.
[6]刘晶晶,袁洪.医院感染的发展状况[J].实用预防医学杂志,2004.11(5):1073.
[7]Askarian M,Gooran NR.National nosocomial infection surveillance system-based study in Iran:additional hospital stay attributable to nosocomial infection[J].Am J Infect Control,2003,31(8):465-468.
[8]Singh AK,Sen MR,Anupurba S,et al.Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU[J].J Conllnun Dis,2002,34(4):257-263.
[9]杨海燕,方静.ICU细菌流行病学调查及护理对策[J].齐齐哈尔医学院学报.2003.24(3):286-288.
[10]张凤运,梁艳芳.SARS流行期间医院感染管理的重点[J].中华医院感染学杂志.2004,14(5):557.
[11]李六亿,章友康.从SARS防治反思我国医院感染管理工作[J].中国医院,2003,7(9):39-42.
[12]韩哲臣.从SARS流行浅谈医院感染管理工作[J].中华医院感染学杂志,2004,14(7):791-793.
[13]王建斌,吴俊霞,张素萍等.后ASRS时代医院感染管理的发展[J].中华医院感染学杂志,2004,14(4):430-432.
[14]张玉华.由SARS引发的对我国医疗卫生工作中三个问题的思考[J].中华医院管理杂志,2003,19(7):385-387.
[15]王发强,陈金宏.防治“非典”工作中实现“院内零感染”的做法[J].中国医院管理杂志,2003,23(7):13-14.
[16]Kohn L,Corrigan J,Donaldson M.To err is human:building a safer health system.Washington,DC[J]:Institute of Medicine,National Academy Press,1999.
[17]Jarvis WR.Selected aspects of the socioeconomic impact of nosocomial infections:morbidity,mortality,cost,and prevention[J].Infect Control HosP Epidemiol 1996,17(8):552-557.
[18]Murray PR,Baron EJ,Pfaller MA,et al.Mannul of clinidal microbiology.7th ed.Washington[J]:ASM Press,1999:107-109.
[19]Levy SB.Multidrug resistance-a sign of the times[J].N Engl J Med,1998,338(19):1376-1378.
[20]于巍。慎用抗生素[J].中国科技纵横,2004,(2):33.
[21]Klevens RM,Edwards JR,Tenover FC,McDonald LC,Horan T,Gaynes R;National Nosocomial Infections Surveillance System.Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals,1992-2003[J].Clin Infect Dis 2006;42:389-391.
[22]National Nosocomial Infections Surveillance(NNIS) system report,data summary from January 1992 through June 2004,issued October 2004[M].Am J Infect Control.2004;32:470-485.
[23]马绪荣,苏德模.药品微生物学检验手册[M].北京:科学出版社.2003:142-145.
[24]Rohrer S,Tschierske M,Zbinden R,et al.Imp roved methods for detection of methicillin-resistant staphylococcus aureus[J].Eur J Clin Microbiol Infect Dis,2001,20(4):267-270.
[25]National Committee for Clinical Labcrtory Standard for Performance Standards for Antimicrobioal Susceptibility Testing[M].Fifth Informational Supplement 2005.M1002S15 Vol.25 No.1.
[26]Fang H,Hedin G.Rapid screening and identification of methicillin-resistant Staphylococcus aureus from clinical samples by selectivebroth and real-time PCR assay[J].J.Clin.Microbiol,2003,41:2894-2899.
[27]Reischl U,Linde HJ,Metz M,et al.Rapid identification of methicillin-resistant Staphylococcus aureus and simultaneous species confirmation using real-time fluorescence PCR[J].J Clin Microbiol,20008:2429-2433.
[28]Killgore GE,Holloway B,et al.A 5- nuclease PCR(TaqMan) high-throughput assay for detection of the mecA gene in staphylococci[J].J Clin Microbiol,2000,38:2516-2519.
[29]Nakatomi Y,Sugiyanma J.A rapid latex agglutination assay for the detection of penicillin-binding proteina[J].Microbial,1998,41(11):739-743.
[30]Van Griethuysen A,Pouw M,van Leeuwen N:et al.Rapid Slide Latex Agglutination Test for Detection of Methicillin Resistance in Staphylococcus aureus[J].Journal of Clinical Microbiology,1999,9(37):2789-2792.
[31]Wisplingoff H,Bischoff T,Tallent SM,et al.Nosocomial bloodstream infection in US hospital analysis of 4,179 cases from a prospective nationwide surveillance study[J].Clin Infect dis,2004,39:309-317.
[32]John Conly.Antimicrobial resistance in Canada[J].CMAJ 2002,167:885-891.
[33]赖晓全.重症监护病房的MRSA[J].实用医学杂志.2004,10(20):1191-1192.
[34]Lim TT,Coombs GW,Grubb WB,et al.Genetic organization of mecA and mecA regulatory genes in epidemic methicillin-resistantst Saphylococcus aureus from Australia and England[J].J Antimrobial Chemotherapy,2002,50:819-824.
[35]Satoshi Hori,Meticillin-resistant Staphylococcus aureus Japan[J].Lancet Infect Dis 2005,5:657-658.
[36]Monina R,Melissa A.Joelle N,et al.Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States[J].JAMA.2007,2(8):1763-1771.
[37]王辉,孙宏莉,陈民钧等.2005年我国五家教学医院革兰阳性球菌耐药监测研究[J].中华检验医学杂志.2006.10(29):873-877.
[38]李家泰,李耘.王进.中国医院和社区获得性感染革兰阳性球菌耐药性监测研究[J].中华医学杂志,2003,83(5):365-374.
[39]李家泰,齐慧敏,李耘.2002-2003年中国医院和社区获得性感染革兰阳性细菌耐药监测研究[J].中华检验医学杂志,2005.28:254-265.
[40]任南,文细毛,吴安华.全国医院感染监控网对医院内金黄色葡萄球菌感染及耐药性监测报告[J].中国医学工程.2007,15:425-427.
[41]Holmes.A,M.Ganner,S.Mcguane,et al.Staphylococcus aureus isolates carring Panton Valentine Leucocidin genes in England and Wales:frequency,characterization and association with clinical disease.2005,43:2384-2390.
[42]John J F,Greishop TJ,Atkins LM,et al.Widespread colonization of personnel at a veterans affair medical center by methicillin resistant,coagulase-negative staphylococcus[J].Clin Infect Dis,1993,17(3):380
[43]Onorato M,Borucki MJ,Baillargeon G,et al.Risk factors for colonization or infectiondue to methicillin-resistant Staphylococcus aureus in HIV-positive patients:a retrospectivecase-control study[J].Infect Control Hop Epidemiol,1999,20(1):26-30
[44]Kaye KS,Fraimow HS,Abrutym E Pathogens resistant to antimicrobial agents-epidemiology,molecular mechanisms,and clinical management[J].Infect Dis Clin North Am,2000,14(2):293-319
[45]DANCER S J.Considering t he int roduction of universal MRSA screening[J].J Hos Inf ect,2008,69:315-320.
[46]KAZAKOVA SV,HAGEMAN JC,MATAVA M,et al.A clone of methicillin resistant S taphylococcus aureus among p rofessional football players[J].N Engl J Med,2005,352(5):468-475.
[47]DELANEY JA,SCHNEIDER L INDNER V,BRASSARD P,et al.Mortality after infection with methicillin resistant S taphylococcus aureus(MRSA) diagnosed in the community[J].BMCMed,2008,6:2.
[48]王进.肖永红.Mohnarin 2006-2007年度报告:革兰阳性菌耐药监测结果[J]中国抗生素杂志,2008.10,33(10):592-596
[49]李家泰,W einstein AJ,杨敏,等.中国细菌耐药监测研究[J].中华医学杂志.2001,81(1):8-16
[50]王进,肖永红,李耘.2004-2005年度全国革兰阳性菌耐药监测(Mohnarin)[J].中华传染病杂志,2008,26(5):268-274.
[51]Centers for Disease Control and Prevention(CDC).Staphylococcus aureus resistant to vancomycin2United States,2002[J].MM WR M orbM orta1W kly Rep,2002,51(26):565-567.
[52]SIEVERT DM,RUDR IK JT,PATEL JB,et al.Vancomycin resistant Staphylococcus aureus in the United States,2002-2006[J].Clin Infect D is,2008, 46(5):668-674.
[53]马越,陈鸿波,姚蕾等.耐甲氧西林金黄色葡萄球菌对万古霉素敏感性的变迁[J].中华内科杂志,2002.41(1):31-33.
[54]Walsh C.Molecular mechanisms that confer antibacterial drug resistance[J].Nature,2000,17(406):775-781.
[55]Hawkey PM.The origins and molecular basis of antibiotic resistance[J].British Medical Journal,1998,5(7159):657-660.
[56]王德海,程国富,胡薛英.耐甲氧西林金黄色葡萄球菌的耐药机制分析[J].中国畜牧兽医,2007,6(34):85-87.
[57]Lim TT,Coombs GW,Grubb WB.Genetic organization of mecA and mecA regulatory genes in epidemic methicillin resistant Staphylococcus aureus from Australia and England[J].J Antimicrob Chemother.2002.50(6):819-824.
[58]Hackbarth CJ,Chamber HF.BlaI and blaR1 regulate β-lactamaseand PBP2a production in methicillin-resistant Staphylococcus aureus[J].Antimicrob Agents Chemother.1993,37:1144-1149.
[59]De Lencastre H.Tomasz A.Reassessment of the number of auxiliary genes essential for expression of high-level methicillin-resistance in Staphylococcus aureus[J].Antimicrob Agents chemother.1994,38(11):2590.
[60]朱中勇.实用医学检验第一版[M].北京:人民军医出版社.1992;658-660
[61]JawadA,SeefirtH,SnellnigA,et al.Suvrival of Acineotbacetr buamannii on dry surfaces:comparisor of outbreak and sporadic isolates[J].J clin Microbiol,1998Jul:36(7):1938-1941.
[62]刘明德.三所医院内不动杆菌的分离及理化因子敏感性研究[J].医院感染与管理杂志,1990:5(1):22.
[63]Berg DE,Hershow RC.Ramirez CA,et al.Control of nosocomial infections in an intensive care unit in Guatemala City[J].Clin Infect Dis.1995,21:588-593.
[64]Wisplinghoff H,Edmond MB,PfallerMA,et al.Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals:clinical features,molecular epidemiology,and antimicrobial susceptibility[J].Clin Infect Dis.2000.31:690-697.
[65]李秀云,徐敏.鲍曼不动杆菌医院感染分析及其防治对策[J].护理学杂志,2004;19(11):70-72.
[66]吴安华,文细毛,任南等.全国医院感染监测网医院感染呼吸道,泌尿道,胃肠道感染病原学及其变迁[J].中国感染控制杂志,2003;2(4):252-255.
[67]任利珍,张翊.革兰阴性杆菌在医院感染的检测及耐药性分析.中华医院感染学杂志[J].2003,13(10):964-965.
[68]李景云,马越,陈鸿波等.1997-2001年不动杆菌属临床分离株分布特点和耐药性分析[J].中国临床药理学杂志.2002,18(6):421-424.
[69]Merino LA,Ronconi MC,Marin M,et al.Non-fermenting bacilli:distribution in clinical specimens and antimicrobial susceptibility[J].Rev Latinoam Microbiol.1999,41(4):279-284.
[70]俞树荣.微生物学和微生物学检验第二版[M].北京.人民卫生出版社.1999.
[71]Joshi SG,Ghole VS,Niphadkar KB.Neonatal gram-negative baceteremia[J].Indian J Pediatr.2000;67(1):27-32.
[72]Lolans K,Rice TW,Munoz-Price LS,et al.Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40[J].Antimicrob Agents Chemother 2006;50:2941-2945.
[73]Manikal VM,Landman D,Saurina G,et al.Endemic carbapenem-resistant Acinetobacter species in Brooklyn,New York:citywide prevalence,interinstitutional spread,and relation to antibiotic usage[J].Clin Infect Dis.2000,3:101-106.
[74]Naas T,Coignard B,Carbonne A,et al.VEB-1 extended-spectrum betalactamaseproducing Acinetobacter baumannii,France[J].Emerg Infect Dis.2006;12:1214-1222.
[75]Coelho JM,Turton JF,Kaufmann ME,et al.Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and Southeast England[J].J Clin Microbiol.2006:44:3623-3627.
[76]Iregbu KC,Ogunsola FT,Odugbemi TO.Infections caused by Acinetobaceter species and their susceptibility to 14 antibiotics in Lagos University Teaching Hospital,Lagos[J].West Afr J Med.2002:21(3):226-229.
[77]Mittal N,Nair D,Gupta N,et al.Outbreak of Acinetobacter spp.Septicemia in a neonatal ICU[J].Southeast Asian J Top Med Public Health.2003;34(2):365-366.
[78]Tejada AA,Bello DS,Chacon VE,et al.Risk factors for nosocomial pneumonia in critically ill trauma patients[J].Crit Care Med.2001,29:304-309.
[79]刘丁,陈萍,陈伟等.鲍曼不动杆菌医院感染的危险因素及基因分型研究[J].中华流行病学杂志.2003,24(2):140-142.
[80]Bergogne-Berezin EJ,Towner K.Acinetobacter spp.as nosocomial pathogens:microbiological,clinical,and epidemiological features[J].Clin Microbiol Rev,1996,9:148-165.
[81]Husni RN,Goldstein LS,Arroliga AC.et al.Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients[J].Chest,1999,115:1378-1382.
[82]Baraibar J,Correa H,Mariscal D,et al.Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia[J].Chest,1997,112:1050-1054.
[83]Sunenshine RA,Wright MO,Maragakis LL.et al.Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization[J].Emerg Infect Dis 2007;13:97-103.
[84]Garnacho J,Sole-Violan J,Sa-Borges M,et al.Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients:a matched cohort study[J].Crit Care Med 2003;31:2478-2482.
[85]胡庆丰,杨广宇,吕火祥等.重症监护病房不动杆菌感染的流行和耐药性分析[J].中国微生态学杂志,2006.18(2):132-133.
[86]徐秀华,李顺强.不动杆菌感染及耐药性的研究[J].中华医学杂志,2000;24(3):116-118.
[87]Bayuga S,Zeana C,Sahni J,et al.Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients:the icegerg phenomenon again[J].Heart Cnag.2002;31(5):382-390.
[88]陶映,陈文光.章泽豹.重症监护病房鲍氏不动杆菌暴发流行控制[J].中华医院感染学杂志.2004.14(10):1183.
[89]Pillay T,Pillay DG,Adhikari M,et al.An outbreak of neonatal infection with Acinetobacter linked to contaminated suction catheters[J].J Hosp Infect,1999;43(4):299-304.
[90]高丽芹,苏吉星.鲍曼不动杆菌致会阴侧切术后切口感染[J].中华医院感染学杂志.2003:13(5):462.
[91]Onarheim H,Hovivik T,Harthug S,et al.Outbreak of multi-resistant Acinetobacter baumannii infection[J].Tidsskr Nor Laegeforen.2000;120(9):1028-1033.
[92]Mcdonald LC,Banerjee SN,Jarvis WR.Seasonal variation of Acinetobacter infetions:1987-1996[J].Clin Inefect Dis.1999;29(5):1133-1137.
[93]Smith PW.Seasonal incidence of Acinetobacter infection[J].J Infect Dis 1979;140:275-276.
[94]Chen MZ,Hsueh PR,Lee LN,et al.Severe communityacquired pneumonia due to Acinetobacter baumannii[J].Chest 2001;120:1072-1077.
[95]Anstey NM,Currie BJ,Hassell M,et al.Communityacquired bacteremic Acinetobacter pneumonia in tropical Australia is caused by diverse strains of Acinetobacter baumannii,with carriage in the throat in at-risk goups.[J]J Clin Microbiol 2002;40:685-686.
[96]Leung WS,Chu CM,Tsang KY.et al.Fulminant communityacquired Acinetobacter baumannii pneumonia as a distinct clinical syndrome[J].Chest 2006;129:102-109.
[97]Tong MJ.Septic complications of war wounds[J].JAMA 1972;219:1044-1047.
[98]Hawley JS,Murray CK,Griffith ME,et al.Susceptibility of acinetobacter strains isolated from deployed U.S military personnel[J].Antimicrob Agents Chemother,2007;51:376-378.
[99]Griffith ME,Lazarus DR,Mann PB,et al.Acinetobacter skin carriage among US army soldiers deployed in Iraq[J].Infect Control Hosp Epidemiol 2007;28:720-722.
[100]Acinetobacter baumannii infections among patients at military medical facilities treating injured U.S.service members,2002-2004[J].MMWR Morb Mortal Wkly Rep 2004:53:1063-1066.
[101]Maegele M,Gregor S,Steinhausen E,et al.The long-distance tertiary air transfer and care of tsunami victims:injury pattern and microbiological and psychological aspects[J].Crit Care Med 2005;33:1136-1140.
[102]Carey RB,Banerjee SN,Srinivasan A.Multidrug-resistant acinetobacter infections,1995-2004[J].Presented at the 46th Interscience Conference on Antimicrobial Agents and Chemotherapy San Francisco,2006,September 27-30.
[103]王露霞,石凌波,徐德兴等.应用纸片扩散法与梯度浓度法测定鲍曼不动杆菌的耐药性[J].第一军医大学学报,2003;23(5):469-471.
[104]Wang H,Chen MJ,Changes of anti-microbial resistance among nonfermenting gram-negative bacilli isolated from intensive care units from 1994 to 2001 in China[J].Zhong Hua Yi Xue Za Zhi.2003;83(5);385-389.
[105]简翠,叶涛,张蓓等.Mohnarin 2006-2007年度报告:中南地区细菌耐药监测[J].中国抗生素杂志.2008:33(10):608-615.
[106]胡云建.Mohnarin 2006-2007年度报告:非发酵革兰阴性杆菌耐药性监测[J].中国抗生素杂志.2008:33(10):597-601.
[107]Giamarellos-Bourboulis E J,Xirouchaki E,Giamarellou H.Interaction of colistin and rifampin on multidrug-resistant A cinetobacter baumannii[J].Dignostic Microbiol and Infect Dis.2001,40:117-120.
[108]Urban C,Mariano N,Rahal JJ.Polymyxin-resistant Acinetobacter baumannii clinical isolate suscep tible to recombinant BPI and cecrop in P1[J].Antim icrob Agents Chem other,2001;45:994-995.
[109]黄小群.ICU医护人员MRSA带菌状况调查研究[J].中国医疗前沿.2008,3(23):109-110.
[110]张春环.ICU鲍曼不动杆菌感染流行情况调查分析[J].哈尔滨医药.2007,27(3):10-11.
[111]同俏静,庄一渝,林洁.鲍曼不动杆菌致下呼吸道感染暴发的调查及干预[J].中华医院管理杂志.2007,23(12):822-824.
[112]戴海,吕爱云,冯海荣.ICU铜绿假单胞菌感染暴发流行的调查[J].江西医学检验.2005,23(3):219-220.
[113]Tenover F.Arbeir R,Goering R.How to select and interpret molecular strain typing methods for epidemiological studies of bacteril infections:a review for healthcare epidemiologists[J].Infect Control Hosp Epidemiol,1997.18:426-439.
[114]A.Deplano,O.Dems,L.Poirel.Molecular Characterization of an Epidemic Clone of Panan tibiofic-Resistant Pseudomonas aeruginosa[J].J Clin Mic,2005,43(3):1198-1204.
[115]郭述良,何礼贤,张磊,等.机械通气患者嗜麦芽窄食单胞菌暴发感染分子流行病学研究[J].中华结核和呼吸杂志志,2005.28(5):310-314.
[116]盂玉芬,韩黎,吴桂芝等.烧伤病房MRSA医院感染暴发的PFGE分型研究[J].微生物学通报,2006,(3):65-69.
[117]Hilmar Wisplinghoff,Birgitta Ewertz,Susanne Wisplinghoff,et al.Molecular Evolution of Methicillin-Resistant Staphylococcus aureus in the Metropolitan Area of Cologne,Germany,from 1984-1998[J].Journal of Clinical Microbiology,2005,43(11):5455-5451.
[118]Scanvic,A.,Denic,L.,Gaillon,S.,et al.Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage[J].Clin.Infect.Dis.2001,32(10),1393-1398.
[119]Sanford M.D,Widmer A.F,Bale M.J,et al.Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus[J].Clin.Infect.Dis.1994,19:1123-1128.
[120]Hyman JM,Jia Li,Stanley EA.The differential infectivity and staged progression models for the transmission of HIV[J].J Mathe-matical Biosciences,1999,155:77-91.
[121]Cooper BS,Medley GF,Scott GM.Preliminary analysis of the transmission dynamics of nosocomial infections:stochastic and management effects[J].J Hosp Infect 1999,43:131-147.
[122]Austin DJ,Bonten MJM,Weinstein RA,et al.Vancomycin-resistant enterococci in intensive-care hospital settings:transmission dynamics,persistence,and the impact of infection control programs[J].Proc Natl Acad Sci USA 1999,96:6908-6913.
[123]张小容.医院工作人员医院感染的原因及预防对策[J].中华医院感染学杂志,2003,13(3):298-300.
[124]McBryde E,Pettitt A,Mc Elwain D.A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit:Predicting the impact of interventions[J].Journal of Theoretical Biology 2007,245:470-481.
[125]Grundmann H,Hori S,Winter B,et al.Risk factor for the transmission of methicillin-resistant Staphylococus aureus in an adult intensive care unit:fitting a model to the data[J].J Infect Dis 2002,185:481-488.
[126]Julia S,Garner,Favero MS.Guideline for Handwashing and Hospital Environmental Control.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116al.ht
[127]Larson EL.AIPC Guideline for Handwashing and Hand antisepsis in Health Care Settings.Am J Infect Control.1995,23:251-69.
[128]中华人民共和国卫生部.医院感染诊断标准(试行)[S].北京:中华人民共和国卫生部,2001.
[129]中华人民共和国卫生部,消毒技术规范2002年版[S],北京:中华人民共和国卫生部,2002
[130]Performance Standards for Antimicrobial Susceptibility Testing;Eingteenth[J].Clincical and Laboratory Standards Institute[S].USA:2008
[131]邹宝波,程科萍,何琅等,某院14年医院感染发病率变迁[J].中国感染控制杂志,2005,4(2):171-172.
[132]许淑琴,俞碗如,汤丽娟等.10245例住院患者医院感染分析[J].浙江预防医学,2005,17(8):33.
[133]文细毛,任南,徐秀华等.全国医院感染监控网医院感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2002,(4):4-7.
[134]朱华芳,王惟,徐晓光.326株病原菌及药敏分析[J].检验医学与临床,2007,4(6):576-577.
[135]陈根娣.44707例住院病例医院感染调查分析[J].临床荟萃.2001,16(8):347-348.
[136]杨月华.医院感染病原菌分布及药敏分析[J].职业与健康.2007.23(8):666-667
[137]柳霞,潜江.ICU院内感染常见致病菌的统计分析[J].当代医学.2009,15(22):21.
[138]张亚莉,马骊.耿穗娜等.医务人员与住院患者鼻前庭携带金黄色葡萄球菌的研究[J].中华医院感染学杂志,2007,17(3):263-266.
[139]Kepler A.Davis,Justin J.Stewart,et al.Methicillin-resistant Staphylococcus aureus(MRSA) nare colonization at Hospital admission and its effect on subsequent MRSA infection[J].Clinical Infectious Diseases,2004,39(6):776-782.
[140]Jarvis WR,Schlosser J,Chinn RY.et al.National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities,2006[J].Am J Infect Control.2007 Dec;35(10):631-637.
[141]Virginie Morange-Saussier,Bruno Giraudeau,Nathalie van der Mee,et al.Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in Vascular Surgery[J].Ann Vasc Surg,2006,20(6):767-772.
[142]Maite Garrouste-Orgeas,Jean-Francois Timsit,Hatem Kallel,et al.Colonization with methicillin-resistant staphylococcus Aureus in ICU patients:morbidity,mortality,and glycopeptide use[J].Infection Control and Hospital Epidemiology,2001,22(11):687-692
[143]Martin D,Ciseros J,Becerril B,et al.Comparison of Repetitive Extragenic palindromic sequence-based PCR method and clinical and microbiological methods for determining strain sources in cases of nosocomial infection Acinettobacter baumannii Bacteremia[J].Journal of Clinical Microbiology.2002;40(12):4571-4575.
[144]McDonald LC,Banerjee SN,Jarvis WR.Seasonal variation of Acinetobacter infections:1987-1996[J].Clin Infect Dis.1999;29(5):1133-1137.
[145]Pedtachaiw.Nosoeonlial Pneurnoulania new bomni tensvieeaer unit[J].J med Assoe Thai,2000:83(4):292-397.
[146]Kuo,L.C,Yu,C.J,Kuo,M.L,et al.Antimicrobial resistance of bacterial isolateds from respiratory care wards in Taiwan:a horizontal surveillance study[J].Int.J.Antimicrob.Agents,31,420-426.
[147]Stephanie J DancerImportance of the environment in meticillin- resistant Staphylococcus aureus acquisition:the case for hospital cleaning.Lancent.2007,http://infection.thelancent.com.October 31,2007.
[148]赵伟英,丁亚娣.邓克勤.ICU鲍曼不动杆菌感染的危险因素分析与护理对策[J].中国实用护理杂志.2007,23(7):59-60.
[149]赖晓全,涂敏.重症监护病房耐甲氧西林金黄色葡萄球菌感染的调查[J].中华传染病杂志,2005.23(4):275-277.
[150]魏全珍,刘丽华,张惠珍等.医务人员患者及陪护、环境MRSA带菌状况调查研究[J].中国实用医药,2008.3(9):15-16.
[151]尚少梅等.医院感染与洗手[J].中华医院感染学杂志2001,11(1):78-80.
[152]魏全珍,张惠珍,刘丽华.烧伤病区患者刨面MRSA医院感染流行的预防与控制[J].中华医院感染学杂志,2007.17(7):816-818.
[153]徐丽英,朱美珍,刘彩霞等.多重耐药鲍曼不动杆菌医院感染的暴发和控制[J].浙江中西医结合杂志.2007,17(5):325-326
[154]陈桂桃.病房条件,周围环境与医院感染的关系分析[J].Chinese MedicaI Research&Clinical.2006,4(5):88
[155]Stephanie J.Dancer.Impotance of the environment in meticillin-resistant Stahpylococcus aureus acquisition:the case for hospital cleaning.http//:infection.the lancet.com,2007:October 31.
[156]Oie S,Hosokawa I,Kamiya A.Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus[J].J Hosp Infect 2002;51:140-143.
[157]王瑶,徐春英.2004-2005年中国CHINET鲍曼不动杆菌耐药性分析[J].中国感染与化疗杂志.2007.7(4):279-282.
[158]王辉.陈民钧.1994-2001年中国重症监护病房非发酵糖菌的耐药变迁[J].中华医学杂志.2003.53(5):253-390.
[159]王辉,陈民钧,倪语星等.2003-2004年中国十家教学医院革兰阴性杆菌的耐药分析fJ].中华检验医学杂志,2005.28(12):1295-1303.
[160]应易高,徐晓雯,徐兆余.鲍曼不动杆菌对抗生素的耐药性监测.同济大学学报(医学版).2007,28(4):80-84
[161]Paton R,MilesRS,Ruiz J,et al.AR I - 1:β - lactamase - mediated imipenem resistance in Acinetobacter baumannii[J].Int J Antim icrob Agents,1993;2:81- 88.
[162]Huys G,CnockaertM,VaneechoutteM,et al.Distribution of tetracycline resistance genes in genotyp ically related and unrelated multiresistant Acinetobacter baum annii strains from different European hospitals[J].ResM icrobiol,2005;156:348-355.
[163]Ribera A,Ruiz J,Vila J.Presence of the TetM determinant in a clinical isolate ofAcinetobacter baumannii[J].Antim icrob Agents Chem other.2003:47:2310-2312.
[164]宋逸萍.鲍曼不动杆菌在重症监护病房的感染及耐药性分析[J].检验医学与临床.2007.4(5):460-461.
[165]江涛,罗永艾.医院获得性鲍曼不动杆菌肺炎的临床调查[J].中华医院感染学杂志,2002,12(4):265-267.
[166]韩雪玲,胡淑芳.华梅等.颅脑外科院内感染经济损失病例调查分析说明[J].实用医技杂志.2006,9:124-126.
[167]陈萍,刘丁,陈伟.鲍曼不动杆菌医院感染调查及其危险因素探讨[J].中国现 代医学.2003,13(4):59-61
[168]Fukuda M,Tanaka H,Kajiwara Y,et al.High-risk populations for nasal carriage of methicillin-resistant Staphylococcus aureus[J].J Infect Chemother,2004,10(3):189-191.
[169]Jernigan,J.A.,A.L.Pullen,et al.Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission[J].Infect Control Hosp Epidemiol,2003,24(6):409-414.
[170]文清泉,岳剑虹.术前碘伏消毒口、鼻腔经鼻气管插管对下呼吸道感染的影响[J].中华医院感染学杂志,2007,17(6):694-695.
[171]周素静,雷俊香,王向阳.神经内科下呼吸道感染危险因素分析[J].中华医院感染学杂志,2007,17(1):38-39.
[172]Meyer E.,Jonas D.,Schwab F.,et al.Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units(SARI)[J].Infection 2003;31(4):208-15.
[173]Rodriguez,Hernandez MJ,Pachon J,Pichardo C,et al.Imipenem.doxycycline and amikacin in monotherapy and in combination in Acinetobacter baumannii experimental pneumonia[J].J Antimicrob Chemother,2000;45(4):493-501.
[174]Kevin Kuzu,RN;Fadime ozer,RN;Semara Aydemir,RN,et al.Compliance with hand hygiene and glove uwe in a university-affiliated hospital[J].Infection control and hospital epidemiology.2005,26(3):312-315.
[175]韩黎,朱士俊,郭燕红等.中国医务人员执行手卫生的现状调查[J].中华医院感染学杂志.2006.16(2):140-142.
[176]冯喆,周待春,孙立英.医护人员手卫生的依从率现状调查与相关影响因素分析[J].中国消毒学杂志.2008.25(3):278-280.
[177]邱方诚,王崇玉.医护人员洗手后葡萄球菌的调查[J].中华医院感染学杂志.2005.15(3):300-301
[178]Torres-Viera C,Dembry LM.Approaches to vancomycin-resistant enterococci[J].Curr Opin Infect Dis.2004,17(6):541-547.
[179]韩黎,郭燕红,朱士俊等.医务人员接触患者后手卫生执行情况的调查分析[J].中华医院管理杂志.2006,22(4):230-232.