医院内不同标本分离的大肠埃希菌耐药相关分析

Drug-resistance of Escherichia coli isolated from different samples of hospital

目的了解医院环境、临床标本、医务人员携带大肠埃希菌情况及其耐药性。方法以前瞻性方法进行调查。2008年5月1日—10月31日,采集某大型综合医院重症监护室(ICU)的环境、医务人员和非ICU医务人员样本,分离大肠埃希菌;临床患者大肠埃希菌资料来自同期检验科微生物室。统计分析各类标本分离的大肠埃希菌对抗菌药物的耐药情况。结果在综合ICU环境中,共采样376份,分离大肠埃希菌69株(18.35%);洗手设施(29.17%)、吸痰器(28.07%)、呼吸机(21.74%)的分离率居前3位。177份医务人员肛拭子标本的大肠埃希菌分离率为45.76%(81/177)。临床患者标本分离大肠埃希菌73株,以大便(21株,28.76%)和尿标本(18株,24.66%)为主。临床标本大肠埃希菌除对头孢哌酮/舒巴坦耐药率(13.70%)低于环境标本(30.43%)外(x^2=5.82,P<0.05),对其他抗菌药物的耐药率,与环境标本差异均无显著性(x^2=0.56～2.89,P>0.05);医务人员与临床和环境标本中分离的大肠埃希菌除对庆大霉素、呋喃妥因、头孢曲松的耐药率无差别外(x^2=1.34～3.12,P>0.05),对其他抗菌药物耐药率均为临床标本和环境标本高于医务人员标本(x^2=10.59～215.28,P<0.05);ICU医务人员与非ICU医务人员分离的大肠埃希菌耐药率差异无显著性(x^2=0.18～2.36,P>0.05)。结论环境中大肠埃希菌的耐药性与患者之间关系密切,环境与患者分离的大肠埃希菌对医务人员肠道大肠埃希菌的耐药性影响较小。

Objective To realize isolation state and drug resistance of Escherichia coli （E. coli） from hospital environment, clinical samples and health care workers（HCWs）. Methods Prospective investigation was performed. From May 1, 2008 to October 31,2008, E. coli were isolated from samples of environment of intensive care unit （ICU）, ICU HCWs and non-ICU HCWs at a large general hospital. Data of E. coli isolated from patients were from clinical microbial laboratory during the same period. Drug resistance of E. coli were analyzed statistically. Results A total of 376 samples were collected from general ICU environment, 69（18. 35%） strains of E. coli were isolated. The isolation rate of E. coli from hand-washing facilities, sputum aspirators and respirators was 29. 17%, 28.07% and 21.74% respectively. The isolation rate of E. coli from 177 HCWs＇ anal swabs was 45. 76% （81/ 177）. 73 strains of E. coli were isolated from clinical samples of patients, most from stool （27 strains, 28. 76%） and urine （18 strains, 24. 66%） samples. Except resistant rate of clinical samples to cefoperazone/sulbactam （13.70%） was lower than 30. 43% of environmental samples （Х^2 = 5.82, P〈0. 05）, the differences in drug resistance to the other antimierobial agents were not significant （Х^2 = 0. 56 - 2.89, P〉0. 05） . There were no significant difference in drug resistant rates of E. coli from HCWs, clinical and environmental samples to gentamycin, nitrofurantoin and ceftriaxone （Х^2 = 1.34 - 3. 12,P〉0. 05）, but resistant rates of E. coli from environmental and clinical samples were higher than that of HCWs （Х^2 = 10. 59- 215.28, P〈0. 05）. the difference in drug resistant rates of E. coli from HCWs in ICU and non-ICU was not significant （Х^2 = 0. 18 - 2. 36,P〉0. 05）. Conclusion Drug resistance of E. coli from environment is closely related with patients, E. coli from environment and patients＇ samples has little effect on drug resistance of intestinal E. coli from HCWs.