ICU耐甲氧西林金黄色葡萄球菌快速监测及防控

Rapid monitoring and prevention of methicillin-resistant Staphylococcus aureus in ICU

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)在ICU的定植、分布及其防控效果。方法新进入ICU病房患者即刻采鼻前庭拭子和72h后符合呼吸道感染指针患者的吸痰导管标本。采用荧光PCR快速检测mecA、nuc基因。并定期对医护人员鼻腔、手等相关环境标本跟踪监测防控。结果 MRSA阳性率检出率:患者鼻前庭拭子为9.9%,吸痰导管为2.7%;医护人员鼻前庭拭子为7.1%、手为4.0%、袖口为4.4%;MRSA阳性医护人员与患者鼻腔采用莫匹罗星擦拭,手加强消毒后MRSA检出率均为0.0%,但每季度医护人员鼻腔MRSA仍有检出。结论 PCR方法阳性率明显高于常规培养方法。鼻腔前庭是MRSA的主要定植部位,是主要感染源,手是重要传播途径,监测重症监护室患者鼻腔前庭及医护人员的鼻腔前庭、手是控制MRSA院内感染的重要防控目标。

Objective To understand the colonization,distribution and prevention of methicillin-resistant Staphylococcus aureus（MRSA）in ICU.Methods The nasal vestibule swabs were immediately taken from new patients in ICU and the sputum suction catheter specimens were collected from the patients conforming to respiratory tract infection at 72 hafter entering ICU.The fluorescence PCR was adopted to rapidly detect mecA,nuc gene.The related environment specimens such as nasal cavity and hands in medical staffs were performed the regular tracking monitoring,prevention and control.Results The MRSA-detection rates were 9.9%for nasal vestibule swabs,2.7%for sputum suction catheter;7.1%for nasal vestibule swabs of medical staffs,4.0%for hands and4.4%for cuffs;the medical staffs and patient′s nasal cavity with MRSA-positive adopted mupirocin for scrubing,MRSA detection rate in hands after reinforce disinfection was 0.0%,but nasal cavity MRSA in medical staff was still detected out every quarter.Conclusion The PCR method has significantly higher positive detection rate compared with the conventional culture method.Nasal vestibule is a major colonization site of MRSA and the main infection source of infection,the hands are the important route of transmission,monitoring nasal vestibule in ICU patients and medical staffs and hands in medical staffs is important to control MRSA nosocomial infection.