ICU环境中耐碳青酶烯类鲍氏不动杆菌污染的调查

Contamination of Carbapenem-resistant Acinetobacter baumannii in Environment of Intensive Care Units

目的调查耐碳青酶烯类鲍氏不动杆菌(CRAB)在ICU环境中的污染情况。方法对上海市21所医院不同ICU环境进行采样,采用ChromID ESBLs筛选耐三代头孢菌素鲍氏不动杆菌,并用琼脂稀释法确认是否为CRAB。结果共采集438份环境微生物标本,其中二级医院104份,三级医院334份;CRAB平均检出率为14.6%;三级医院CRAB检出率(17.7%)明显高于二级医院(4.8%),差异有统计学意义(P<0.01);CRAB最高检出浓度达(1×107)CFU/cm2,呼吸机表面CRAB检出率明显高于心电监测仪(P=0.026)和输液泵表面(P=0.009)。结论上海市ICU环境中普遍存在CRAB污染,应加强ICU环境消毒和耐药菌监测,预防和控制CRAB感染。

OBJECTIVE To investigate the contamination of carbapenem-resistant Acinetobacter baumannii （CRAB） in intensive care units （ICUs） environment in Shanghai hospitals. METHODS Environmental samples were collected from different ICUs in 21 hospitals. ChromID ESBL medium were used to isolate A. baumannii strains resistance to third generation cephalosporins. CRAB were confirmed by agar dilution MIC methods. RESULTS A total of 438 samples were collected from district hospitals （104 samples） and tertiary hospitals （334 samples）. The isolated rate of CRAB was 14. 6% overall, while in district and tertiay hospitals the rate was 4. 8% and 17.7%, respectively （P=0. 001） . The maximal detectable concentration of CRAB was 1 × 107 CFU/cm2. The isolate rate of CRAB on the surface of ventilator was higher than that of ECG monitors （P=0. 026） and the infusion pumps （P= 0. 009）. CONCLUSIONS The contamination of CRAB in ICU environment in Shanghai hospitals is universal. Environmental disinfection and monitoring of drug resistant pathogens should be taken to prevent and control nosocomial infection with CRAB.