华中科技大学协和深圳医院 ICU 患者 鼻咽部及医疗环境定植菌群分析

Analysis of Nasopharyngeal and Medical Environment Colonization Flora of ICU Patients in Huazhong University of Science and Technology Union Shenzhen Hospital

摘要:

〔摘 要〕 目的：调查华中科技大学协和深圳医院综合重症监护病区（ICU）患者鼻咽部及医疗环境定植菌群分布情 况，为预防和控制 ICU 院内感染提供流行病学依据。方法：采用现场流行病学调查方法，于 2021 年 12 月至 2022 年 3 月对华中科技大学协和深圳医院 ICU 收治患者的鼻咽部、医疗环境及医务工作人员手部进行大规模卫生采样检测。 采用 VITEK 2–compact 全自动微生物分析仪进行菌种鉴定。结果：患者鼻咽部检出致病菌 38 株，革兰阴性杆菌：主 要为铜绿假单胞杆菌 6 株（15.8 %），鲍曼不动杆菌 3 株（7.9 %）；革兰阳性菌球菌：主要为表皮葡萄球菌 4 株（10.5 %）， 溶血性葡萄球菌 3 株（7.9 %），屎肠球菌 3 株（7.9 %）；真菌：白色念珠菌 7 株（18.4 %），光滑念珠菌 1 株（2.6 %）， 近平滑念珠菌 1 株（2.6 %）；34.8 % 的医疗环境存在细菌污染，污染菌种主要为表皮葡萄球菌 41.5 %，溶血性葡萄 球菌 26.1 %，鲍曼不动杆菌 10.3 %，粪肠球菌 6.4 %，金黄色葡萄球菌 4.7 %，铜绿假单胞杆菌 4.3 %，屎肠球菌 2.1 %； 白色念珠菌 1.3 %，近平滑念珠菌 1.3 %；最常见的污染样本来源于输液泵 / 架 19.7 %，床垫 14.5 %，气压泵 11.1 %， 吊塔 9.4 %，床栏 8.5 %，听诊器 7.3 %，监护显示器 5.1 %，水龙头 4.7 %，医护及护理人员手 3.4 %，其他 16.2 %。结论：ICU 患者鼻咽部与医疗环境分离菌株大致相符，环境污染严重，是医院内感染的主要原因。

Abstract:

〔Abstract〕 Objective To investigate the distribution of colonized bacteria in nasopharynx and medical environment of ICU patients in Huazhong University of Science and Technology Union Shenzhen Hospital, and to provide epidemiological basis for the prevention and control of nosocomial infection in ICU. Methods Using the field epidemiological investigation method, a large scale health sampling and detection of nasopharynx, medical environment and hands of medical staff of patients admitted to Huazhong University of Science and Technology Union Shenzhen Hospital were conducted from December 2021 to March 2022. The strains were identified by VITEK 2-compact automatic microbiological analyzer. Results 38 strains of pathogenic bacteria were detected in the nasopharynx of the patient, gram-negative bacilli: including 6 strains of pseudomonas aeruginosa (15.8 %) and 3 strains of acinetobacter baumannii (7.9 %); Gram-positive bacteria: 4 strains of staphylococcus epidermidis (10.5 %), 3 strains of staphylococcus hemolyticus (7.9 %), 3 strains enterococcus faecium (7.9 %); fungus: 7 strains of candida albicans (18.4 %), 1 strain of candida glabrata (2.6 %), 1 strain of candida parapsilosis (2.6 %), 34.8 % of the medical environment had bacterial contamination, the main bacteria were staphylococcus epidermidis 41.5 %, staphylococcus hemolyticus 26.1 %, acinetobacter baumannii 10.3 %, enterococcus faecalis 6.4 %, staphylococcus aureus 4.7 %, pseudomonas aeruginosa 4.3 % and enterococcus faecium 2.1 %, candida albicans 1.3 %, candida parapsilosis 1.3 %; The most common contamination samples came from infusion pumps/racks 19.7 %, mattresses 14.5 %, pneumatic pump 11.1 %, head mast 9.4 %, bed rail 8.5 %, stethoscope 7.3 %, monitor display 5.1 %, faucet 4.7 %, medical and nursing staff hand 3.4 %, other 16.2 %. Conclusion The strains isolated from the nasopharynx of ICU patients are roughly consistent with those from the medical environment. The serious environmental pollution is the main cause of nosocomial infection.