某院综合ICU耐碳青霉烯革兰阴性杆菌的环境流行调查

Survey on environmental prevalence of carbapenem-resistant organism in a general ICU

目的分析某院重症监护病房(ICU)环境物表和洗手池耐碳青霉烯革兰阴性杆菌(carbapenem-resistant organism,CRO)的污染现状及其耐药情况,从而为ICU病房CRO防控提供支持依据。方法采用mSuper CARBA显色培养基对某院综合ICU水池和患者周围高频接触物进行采样和培养,采用YZB/国1402-2008细菌鉴定及药敏测试仪进行菌株鉴定和药敏试验。结果某院综合ICU病房22个洗手池和11例CRKP定植/感染患者周围物表共设置110个采集位点,其中22个水池的池壁、池孔44个采集位点,患者周围高频接触物表66个采样位点。CRO的总体分离率较高(51.82%,57/110),其中患者周围高频接触物表的分离率为15.15%(10/66),10个采样位点共分离出14株CRO,检出菌以CRKP(4/14)、CRAB(5/14)、CRPA(2/14)为主;洗手池的分离率为97.73%(43/44),43个采样位点共分离93株菌株,检出菌以CRKP(13/93,13.98%)、CRPA(29/93,31.18%)、CRCF(19/95,20.43%)为主。CRKP、CRPA和CRCF的耐药率均较高。17株CRKP对16种常用抗菌药物的耐药率均>35.29%,对美罗培南耐药率为100%;29株CRPA对黏菌素的耐药率低(6.45%);19株CRCF对阿米卡星、左氧氟沙星和米诺环素耐药率相对低(5.26%~21.05%),对其余药物耐药率为52.63%~100.00%。结论该院综合ICU洗手池CRO定植率较高,而患者周围高频接触物表CRO定植率相对偏低,应加强落实洗手池的消毒,采取减少通过洗手池交叉传播的预防控制措施,同时加强对患者周围环境物表的环境清洁与消毒措施,预防和控制CRO医院感染的发生。

Objective To provide support for the prevention and control of carbapenem-resistant organism(CRO)in the intensive care unit(ICU)wards through analyzing the environmental pollution status and resistance of CRO in the ICU environment and the sink.Methods Specimens collected from high-frequency contact object surface,wall,and drain holes of sink in general ICU were performed microbial isolation by mSuper CARBA chromogenic medium,and the YZB/National 1402-2008 bacterial identification and drug susceptibility tester was used for strain identification and drug susceptibility testing.Results A total of 110 collection points were set on the 22 hand-washing sink and surface around the 11 CRKP colonization/infection patients;44 collection sites were set on the walls and holes of 22 sink,and 66 sampling sites were set on high-frequency contact objects around the patient.The separation rate of CRO was relatively high(51.82%,57/110),and a total of 14 strains were isolated from 10 sampling sites.Among these strains,there were CRKP(4/14),CRAB(5/14),and CRPA(2/14).The separation rate of the highfrequency contact object surface was 15.15%(10/66),and 93 strains were isolated from 43 sampling sites,and the separation rate was 97.73%(43/44).The isolated strains included CRKP(13/93,13.98%),CRPA(29/93,31.18%),and CRCF(19/93,20.43%).The resistance rates of 17 CRKP strains to 16 antimicrobial drugs were all>35.29%,and the resistance rates to meropenem were 100%;the resistance rates of 29 CRPA strains to colistin were low(6.45%);the resistance rates of 19 CRCF strains to amikacin,levofloxacin,and minocycline were low(5.26%~21.05%),and the resistance rates to the other drug susceptibility test drugs were 52.63%~100.00%.Conclusion Compared with the sink,the colonization rate of CRO of high-frequency contact object surface was relatively low in the general ICU.The disinfection of the sink should be strengthened,and preventive and control measures to reduce cross-transmission through the sink should be taken.Environmental cleaning and disinfection measures for the surrounding environment of patients to prevent and control the occurrence of CRO health-associated infections.