医院环境物体表面及医务人员手分离病原菌对抗菌药物和消毒剂的耐药性

Antimicrobial and disinfectant resistance of pathogens isolated from hospital environmental inanimate surfaces and hands of health care workers

摘要:

目的了解医院环境物体表面及医务人员手分离的病原菌种类，及其对医院常用抗菌药物和消毒剂的耐药性。方法对北京市某城区16所医院重症监护病房、普通病房环境物体表面和医务人员手分离的病原菌进行细菌鉴定及药敏试验、消毒剂抗性试验，并检测病原菌对抗菌药物和消毒剂耐药的基因携带情况。结果16所医院环境物体表面和医务人员手共采集标本979份，检出病原菌75株（7.66%），以革兰阴性（G-）杆菌为主（占78.67%），其中铜绿假单胞菌（24株）、阴沟肠杆菌（14株）和肺炎克雷伯菌（4株）居前3位。有1株铜绿假单胞菌对氨曲南、庆大霉素、妥布霉素、环丙沙星和左氧氟沙星耐药；1株阴沟肠杆菌对哌拉西林耐药，7株对呋喃妥因耐药；4株肺炎克雷伯菌对哌拉西林全耐药，2株对头孢类抗菌药物耐药，1株对美罗培南耐药。铜绿假单胞菌有7个耐药基因阳性，以mir阳性率最高（100.00%）；阴沟肠杆菌有4个耐药基因阳性，tem 1和shv阳性率均为100.00%；肺炎克雷伯菌有5个耐药基因阳性，shv和mir阳性率均为100.00%。铜绿假单胞菌和阴沟肠杆菌对葡萄糖酸氯己定（耐药率分别为4.17%、57.14%）和三氯异氰尿酸（均为50.00%）均产生耐药，两种菌消毒剂耐药基因（qacE△1sul 1）阳性率分别为79.17%、57.14%；肺炎克雷伯菌对两种消毒剂均无耐药性，均未检出耐药基因。结论医院环境物体表面和医务人员手均存在多种引起医院感染的常见病原菌，以G-杆菌为主，且病原菌均出现不同程度的对抗菌药物和消毒剂耐药。

Abstract:

ObjectiveTo investigate the types, antimicrobial resistance, and disinfectant resistance of pathogens isolated from hospital environmental inanimate surfaces and hands of health care workers (HCWs).MethodsPathogens isolated from hospital environmental inanimate surfaces and hands of HCWs in intensive care units and general wards in 16 hospitals in Beijing were performed bacterial identification, antimicrobial susceptibility testing, and disinfectant resistance testing. The carriage of antimicrobial resistance genes and disinfectant genes in pathogens were also detected.ResultsA total of 979 specimens were collected from inanimate surfaces and hands of HCWs in 16 hospitals, 75（7.66%）pathogenic strains were isolated, 78.67% of which were gramnegative bacilli. The top 3 pathogens were Pseudomonas aeruginosa (P.aeruginosa, n=24), Enterobacter cloacae (E. cloacae, n=14), and Klebsiella pneumoniae (K. pneumoniae, n=4). One P. aeruginosa strain was resistant to aztreonam, gentamycin, tobramycin, ciprofloxacin, and levofloxacin; One E. cloacae strain was resistant to piperacillin, 7 strains were resistant to nitrofurantoin; 4 K. pneumoniae strains were all resistant to piperacillin, 2 were resistant to cephalosporins, and 1 was resistant meropenem. P. aeruginosa had 7 drugresistant genes, positive rate of mir was 100.00%; E. cloacae had 4 drugresistant genes, positive rates of tem 1and shv were both 100.00%; K. pneumoniae had 5 drugresistant genes, positive rates of shv and mir were both 100.00%. The resistant rates of P. aeruginosa and E. cloacae to chlorhexidine gluconate were 4.17% and 57.14% respectively, to trichloroisocyanuric acid were both 50.00%, positive rates of drugresistant genes （qacE△1sul 1）were 79.17% and 57.14% respectively； K. pneumoniae had no resistance to two kinds of disinfectant, dugresistance gene was not found.ConclusionMultiple common pathogens which can cause healthcareassociated infection exist in hospital environmental inanimate surfaces and hands of HCWs, which are dominated by gramnegative bacilli, pathogens had resistance to antimicrobial agents and disinfectant in different degrees.