某综合医院重症监护病房耐碳青霉烯类肺炎克雷伯菌环境流行调查
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高晓东

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R181.3+2

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复旦大学附属中山医院院内课题(2019ZSQN60)


Survey on environmental prevalence of carbapenem-resistant Klebsiella pneumoniae in intensive care unit of a general hospital
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    摘要:

    目的 调查重症监护病房(ICU)环境中耐碳青霉烯类肺炎克雷伯菌(CRKP)污染现状,以及CRKP主要耐药基因携带情况。方法 使用mSuper CARBA显色培养基对某院5个外科ICU中高频接触的物体表面、公共区域物体表面、水槽池壁和排水孔等采样标本进行菌株分离,采用MALDI-TOF质谱仪对目标菌进行鉴定,采用双纸片协同法对CRKP进行碳青霉烯酶表型鉴定,聚合酶链反应(PCR)方法检测KPC和NDM耐药基因。结果 CRKP在高频接触的物体表面(1/73)、公共区域物体表面(1/89)、护工的衣物(1/24)分离比例很低,但水槽排水孔(25/29)污染比例较高。碳青霉烯酶表型鉴定显示,5株产A类酶,11株产B类金属酶;PCR结果显示,2株携带KPC耐药基因,3株携带NDM耐药基因。结论 CRKP在ICU高频接触的物体表面定植率较低,而水槽排水孔污染率较高。耐药表型酶鉴定和PCR结果提示,严格执行环境清洁与消毒措施后,ICU内CRKP交叉传播的可能降低。

    Abstract:

    Objective To survey the enviromental contamination of carbapenem-resistant Klebsiella pneumoniae(CRKP) in intensive care unit (ICU) and carriage of drug resistance genes of CRKP. Methods Specimens collected from high-touch object surface, object surface in public area, wall and drain holes of sink in 5 surgical ICUs were performed microbial isolation by mSuper CARBA chromogenic medium, targeted strains were identified by MALDI-TOF mass spectrometry, carbapenemase phenotype of CRKP was identified by double-disk synergy method, KPC and NDM resistance genes were detected by polymerase chain reaction (PCR). Results The isolation proportion of CRKP from high-touch object surface (1/73), object surface in public area (1/89), attendants' clothing (1/24) were very low, but from drain hole of sink was higher (25/29). Identification of carbapenemase phenotype showed that 5 strains produced class A enzyme and 11 strains produced class B metalloenzyme; PCR results showed that 2 strains carried KPC resistance genes and 3 strains carried NDM resistance genes. Conclusion Colonization rate of CRKP on high-touch object surface in ICU is low, but contamination rate of drain hole of sink is high. The results of resis-tance phenotype enzyme identification and PCR revealed that cross transmission of CRKP in ICU may be low if environmental cleaning and disinfection measures are strictly implemented.

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史庆丰, 黄英男, 孙伟,等.某综合医院重症监护病房耐碳青霉烯类肺炎克雷伯菌环境流行调查[J]. 中国感染控制杂志,2020,19(12):1093-1097. DOI:10.12138/j. issn.1671-9638.20206069.
SHI Qing-feng, HUANG Ying-nan, SUN Wei, et al. Survey on environmental prevalence of carbapenem-resistant Klebsiella pneumoniae in intensive care unit of a general hospital[J]. Chin J Infect Control, 2020,19(12):1093-1097. DOI:10.12138/j. issn.1671-9638.20206069.

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  • 收稿日期:2019-12-13
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  • 在线发布日期: 2020-12-28
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