综合医院ICU患者及环境分离多重耐药菌耐药率及同源性

Antimicrobial resistance and homology of the multidrug-resistant organi-sms isolated from patients and environment of the intensive care unit in a general hospital

摘要:

目的 调查某院重症监护病房（ICU）患者及环境分离多重耐药菌（MDRO）同源性，为临床预防控制MDRO感染提供依据。 方法 收集2021年11月17日—12月17日某三级甲等综合医院重症监护病房（ICU）患者及环境分离的MDRO，对分离株进行药敏分析以及脉冲场凝胶电泳（PFGE）试验及聚类分析。 结果 共收集22株MDRO[耐碳青霉烯类肺炎克雷伯菌（CRKP）6株，多重耐药鲍曼不动杆菌（MDR-AB）11株，耐甲氧西林金黄色葡萄球菌（MRSA）5株]，其中临床患者来源菌株11株，环境来源菌株11株，部分环境株与临床株高度同源。ICU环境，包括工作人员生活区域物体表面、微波炉按键和开关等均检出MDRO。患者床旁桌和水池消毒处理后仍被检出CRKP、MDR-AB，护理员洗手后手检出与患者使用的听诊器完全同源的MRSA。CRKP对常用抗菌药物均耐药（头孢他啶/阿维巴坦除外）；MDR-AB临床株对米诺环素耐药率为40.0%，对其他抗菌药物耐药率均≥60%，MDR-AB环境株耐药率较临床株低。 结论 ICU MDRO临床株与环境株高度同源，存在MDRO通过医院环境在医院传播和交叉感染的可能。应加强环境清洁消毒措施的落实，提高手卫生依从性，切断病原菌医院传播途径，减少MDRO医院感染的发生。

Abstract:

Objective To investigate the homology of the multidrug-resistant organisms (MDROs) isolated from patients and environment of intensive care unit (ICU) in a hospital, and provide evidence for clinical prevention and control of MDRO infections. Methods MDROs isolated from patients and environment of ICU in a tertiary first-class hospital from November 17 to December 17, 2021 were collected. Antimicrobial susceptibility test, pulsed-field gel electrophoresis (PFGE) and cluster analysis were conducted on the isolated strains. Results A total of 22 MDROs were collected, including 6 carbapenem-resistant Klebsiella pneumoniae (CRKP) strains, 11 multidrug-resistant Acinetobacter baumannii (MDR-AB) strains and 5 methicillin-resistant Staphylococcus aureus (MRSA) strains. 11 strains each were isolated from clinical patients and environment. Some of the environmental strains were highly homologous to the clinical strains. MDROs were isolated from ICU environment such as the surfaces of objects in the staff's living area, microwave oven buttons, switches, etc. CRKP and MDR-AB were isolated even after disinfection of patient bedside tables and sinks. MRSA identical to that from the stethoscope used by patient was isolated from nurses' hands after hand washing. CRKP was resistant to all commonly used antimicrobial agents (except ceftazidime/avibactam). MDR-AB clinical strains showed a resistance rate of 40.0% to minocycline, and resis-tance rates ≥ 60% to other antimicrobial agents; while environmental strains of MDR-AB had a lower resistance rate than the clinical strains. Conclusion Clinical MDRO strains from ICU are highly homologous to the environmental strains, suggesting the possibility of MDRO transmission and cross-infection through the hospital environment. Therefore, it is necessary to strengthen the implementation of environmental cleaning and disinfection measures, improve hand hygiene compliance, and cut off the transmission of pathogenic bacteria in hospital to reduce the incidence of MDROs.