哈尔滨市医院重症监护室环境病原菌分布特征及多重耐药性研究
|
摘要
目的了解哈尔滨市医院重症监护室(ICU)环境物体表面、医务人员手病原菌群种类和分布情况及病原菌对抗菌药物的耐药性,为探明医院感染传播途径及传播媒介提供主要依据。方法对哈尔滨市10家医院ICU环境物体表面及医务人员手采样后进行细菌分离鉴定及药敏试验,并按不同采集区域分别进行统计分析。结果共采集ICU动态环境标本724份,检出病原菌479份,其中革兰氏阳性菌344株,占71.8%,革兰氏阴性菌135株,占28.2%;分离的病原菌株数位于前3位的分别是表皮葡萄球菌81株、松鼠葡萄球菌73株、鲍氏不动杆菌66株。主要的革兰氏阴性菌对氨苄西林、头孢哌酮、头孢孟多、头孢噻肟的耐药率较高,主要的革兰氏阳性菌对磺胺复合物、甲氧苄氨嘧啶、四环素、氨苄西林的耐药率较高。结论 ICU环境物体表面和医务人员手均分离出多种引起医院感染的常见病原菌,主要以革兰氏阳性菌为主,且对抗菌药物均有不同程度的耐药性。
Objective To investigate the species,distribution of pathogenic bacteria and the resistance of pathogenic bacteria to antibiotics on the surface of environmental objects and hands of medical staff in the Intensive Care Unit(ICU) of Harbin,provide the main basis for finding out the transmission route and media of nosocomial infection.Methods Bacterial isolation,identification and drug susceptibility test were carried out on the surface of ICU environmental objects and samples from hands of medical staff in 10 hospitals in Harbin.Statistical analysis was carried out according to different collecting areas.Results A total of 724 ICU dynamic environmental samples were collected from 10 hospitals in Harbin,and 479 samples were detected with pathogenic bacteria.Among all pathogenic bacteria,344 strains were Gram-positive bacteria(71.8%) and 135 strains were Gram-negative bacteria(28.2%).Among the isolated pathogenic bacteria,Staphylococcus epidermidis(81 strains),Staphylococcus squirrel(73 strains) and Acinetobacter baumannii(66 strains) were the top three.The resistance rates of major Gram-negative bacteria to ampicillin,cefoperazone,cefamandol and cefotaxime were relatively high,while the resistance rates of major Gram-positive bacteria to sulfonamide complex,trimethoprim,tetracycline and ampicillin were higher.Conclusion Many common pathogenic bacteria causing nosocomial infections are isolated from the surface of ICU environmental objects and the hands of medical staff,Gram-positive bacteria are the predominant pathogens.The pathogens have different degrees of resistance to antimicrobial drugs.
Objective To investigate the species,distribution of pathogenic bacteria and the resistance of pathogenic bacteria to antibiotics on the surface of environmental objects and hands of medical staff in the Intensive Care Unit(ICU) of Harbin,provide the main basis for finding out the transmission route and media of nosocomial infection.Methods Bacterial isolation,identification and drug susceptibility test were carried out on the surface of ICU environmental objects and samples from hands of medical staff in 10 hospitals in Harbin.Statistical analysis was carried out according to different collecting areas.Results A total of 724 ICU dynamic environmental samples were collected from 10 hospitals in Harbin,and 479 samples were detected with pathogenic bacteria.Among all pathogenic bacteria,344 strains were Gram-positive bacteria(71.8%) and 135 strains were Gram-negative bacteria(28.2%).Among the isolated pathogenic bacteria,Staphylococcus epidermidis(81 strains),Staphylococcus squirrel(73 strains) and Acinetobacter baumannii(66 strains) were the top three.The resistance rates of major Gram-negative bacteria to ampicillin,cefoperazone,cefamandol and cefotaxime were relatively high,while the resistance rates of major Gram-positive bacteria to sulfonamide complex,trimethoprim,tetracycline and ampicillin were higher.Conclusion Many common pathogenic bacteria causing nosocomial infections are isolated from the surface of ICU environmental objects and the hands of medical staff,Gram-positive bacteria are the predominant pathogens.The pathogens have different degrees of resistance to antimicrobial drugs.
引文
[1] Montero JG,Lerma FA,Galleymore PR,et al.Combatting resistance in intensive care:the multimodal approach of the Spanish ICU “Zero Resistance” program[J].Critical Care,2015,19(1):800-807.
[2] Jones RN,Flonta M,Gurler N,et al.Resistance surveillance program report for selected European nations(2011)[J].Diagnostic Microbiology and Infectious Disease,2014,78(4):429-436.
[3] Bassetti M,Kollef MH,Poulakou G.Principles of antimicrobial stewardship for bacterial and fungal infections in ICU[J].Intens Care Med,2017,43(12):1894-1897.
[4] 刘清宏,周春兰.ICU机械通气患者下呼吸道感染相关危险因素及护理[J].护理学报,2014,21(6):42-45.
[5] 王会平,张洪江,董歧,等.朝阳区医院环境中病原菌种类分布调查[J].中国消毒学杂志,2014,31(12):1298-1300.
[6] Cheng VCC,Wong SC,Chen JHK,et al.Control of multidrug-resistant Acinetobacter baumannii in Hong Kong:role of environmental surveillance in communal areas after a hospital outbreak[J].Am J Infect Control,2018,46(1):60-66.
[7] Lei J,Han S,Wu W,et al.Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit[J].Am J Infect Control,2016,44(11):1280-1284.
[8] Cheng VCC,Chen JHK,Poon RWS,et al.Control of hospital endemicity of multiple-drug-resistant Acinetobacter baumannii ST457 with directly observed hand hygiene[J].European Journal of Clinical Microbiology & Infectious Diseases,2015;34(4):713-718.
[9] 谈宜斌,李源,田佳,等.重症监护病房鲍曼不动杆菌感染暴发事件调查[J].中国消毒学杂志,2018,35(8):627-629.
[10] 廖云凤,严立.2013-2016年重庆市血流感染病原菌分布及耐药性分析[J].国际检验医学杂志,2018,39(21):2654-2661,2665.
[11] 何雁鸿,沈丽莉.医院2013年至2016年临床分离菌耐药性分析[J].中国药业,2017,26(24):64-67.
[12] 刘卫平,乔一峰,李昊雪,等.2015-2017年某三级综合医院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,2018,28(18):2773-2777.
[13] Lzureanu V,Poro?nicu M,Gandac C,et al.Infection with Acinetobacter baumannii in an intensive care unit in the Western part of Romania [J].BMC Infectious Diseases,2016,16:95.
[14] 归巧娣,解娟,范芸,等.2014-2016 年 ICU 鲍曼不动杆菌耐药结果分析[J].医学动物防制,2018,34(12):1126-1128.
[2] Jones RN,Flonta M,Gurler N,et al.Resistance surveillance program report for selected European nations(2011)[J].Diagnostic Microbiology and Infectious Disease,2014,78(4):429-436.
[3] Bassetti M,Kollef MH,Poulakou G.Principles of antimicrobial stewardship for bacterial and fungal infections in ICU[J].Intens Care Med,2017,43(12):1894-1897.
[4] 刘清宏,周春兰.ICU机械通气患者下呼吸道感染相关危险因素及护理[J].护理学报,2014,21(6):42-45.
[5] 王会平,张洪江,董歧,等.朝阳区医院环境中病原菌种类分布调查[J].中国消毒学杂志,2014,31(12):1298-1300.
[6] Cheng VCC,Wong SC,Chen JHK,et al.Control of multidrug-resistant Acinetobacter baumannii in Hong Kong:role of environmental surveillance in communal areas after a hospital outbreak[J].Am J Infect Control,2018,46(1):60-66.
[7] Lei J,Han S,Wu W,et al.Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit[J].Am J Infect Control,2016,44(11):1280-1284.
[8] Cheng VCC,Chen JHK,Poon RWS,et al.Control of hospital endemicity of multiple-drug-resistant Acinetobacter baumannii ST457 with directly observed hand hygiene[J].European Journal of Clinical Microbiology & Infectious Diseases,2015;34(4):713-718.
[9] 谈宜斌,李源,田佳,等.重症监护病房鲍曼不动杆菌感染暴发事件调查[J].中国消毒学杂志,2018,35(8):627-629.
[10] 廖云凤,严立.2013-2016年重庆市血流感染病原菌分布及耐药性分析[J].国际检验医学杂志,2018,39(21):2654-2661,2665.
[11] 何雁鸿,沈丽莉.医院2013年至2016年临床分离菌耐药性分析[J].中国药业,2017,26(24):64-67.
[12] 刘卫平,乔一峰,李昊雪,等.2015-2017年某三级综合医院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,2018,28(18):2773-2777.
[13] Lzureanu V,Poro?nicu M,Gandac C,et al.Infection with Acinetobacter baumannii in an intensive care unit in the Western part of Romania [J].BMC Infectious Diseases,2016,16:95.
[14] 归巧娣,解娟,范芸,等.2014-2016 年 ICU 鲍曼不动杆菌耐药结果分析[J].医学动物防制,2018,34(12):1126-1128.