新生儿病房分离金黄色葡萄球菌耐药性及耐消毒剂基因检测

目的了解新生儿病房送检标本中金黄色葡萄球菌的耐药谱及耐消毒剂基因携带情况。方法收集2013年1—12月某院新生儿病房住院新生儿送检标本分离的金黄色葡萄球菌,采用VITEK2 Compact细菌鉴定分析系统进行细菌鉴定及药敏试验,采用聚合酶链反应(PCR)检测耐消毒剂qacA/B基因。结果新生儿科送检标本中共分离225株金黄色葡萄球菌,主要来源于呼吸道(72.44%)和脐部分泌物(14.33%);耐甲氧西林金黄色葡萄球菌(MRSA)检出率为8.89%(20株);耐药监测中,MRSA的耐药率普遍高于甲氧西林敏感金黄色葡萄球菌(MSSA)。左氧氟沙星、莫西沙星、替加环素、万古霉素、利奈唑胺及呋喃妥因对所有金黄色葡萄球菌均显示出良好的抗菌活性,敏感率均为100%。携带qacA/B基因的金黄色葡萄球菌有21株,阳性率为9.33%,其中MRSA3株(15.00%),MSSA18株(8.78%)。结论新生儿病房分离的MRSA耐药严重,同时携带qacA/B基因,应引起临床重视。     

Staphylococcus aureus still colonizes the untreated neonatal umbilicus.

Two different neonatal umbilical cord treatment regimens were studied prospectively. Although a greater proportion of cords had separated by the seventh day in those babies not treated with topical antiseptics (47% vs. 26%), there was a significant excess (53% vs. 30%) of umbilical colonization by Staphylococcus aureus compared to those neonates whose cords were treated with alcohol wipes and hexachlorophane powder. The main purpose of treating cords is to prevent significant S. aureus colonization, and therefore current proposals to stop antiseptic treatment of umbilical cords should be disregarded.     

Staphylococcus aureus colonization of the newborn in a Darlington hospital.

Evidence from research studies suggests a relationship between neonatal infection with Staphylococcus aureus and the level of umbilical colonization. During a 3-month prospective study (September-December 1990) the incidence and levels of S. aureus colonization were determined for all 370 live births in the Darlington Unit by taking swabs at 48 h and 8/9 days from the base of the umbilical cord. Infants were situated in one of four locations (The Special Care Unit, one of two wards or home) and the location at the time of swabbing was recorded. The overall percentages colonized at 48 h and 8/9 d were 68% and 65% respectively. Forty-eight hours after delivery, 49% showed a high level of S. aureus colonization. Although the percentage of infants colonized with S. aureus was almost identical at each sampling, only 62% were culture-positive on both occasions. Between 48 h and 8/9 days, 12% (44) of infants developed S. aureus infections of whom 35 showed heavy growth. Statistical analysis showed a significant relationship between levels of colonization at the two sampling times but no relationship between location and levels of colonization over the time period.     

消毒湿巾对新生儿病房环境物体表面消毒的效果

目的比较消毒湿巾与含氯消毒剂的消毒效果,为改进医院感染防控措施提供依据。方法按消毒方法分为伽玛卫生湿巾组、洁力佳表面消毒巾组和84消毒剂组,分别对新生儿病房床单位进行清洁消毒,在消毒前及消毒后5、10、30、60 min五个时间点对新生儿病房床单位表面采样,每组每个时间点分别采集标本30份,比较组间细菌菌落数、杀灭率和消毒合格率,同时筛查物体表面耐甲氧西林金黄色葡萄球菌(MRSA)检出情况。结果消毒后5、10、30 min,床单位物体表面三组间细菌菌落数及杀灭率比较,差异无统计学意义(P0.05)。消毒后60 min,细菌菌落数伽玛卫生湿巾组[(2.61±0.41)CFU/cm~2]、洁力佳表面消毒巾组[(2.71±0.42)CFU/cm~2]低于84消毒剂组[(4.08±0.33)CFU/cm~2],差异有统计学意义(P0.05);细菌杀灭率伽玛卫生湿巾组[(72.36±3.90)%]、洁力佳表面消毒巾组[(71.49±4.77)%]优于84消毒剂组[(55.92±3.22)%],差异有统计学意义(P0.05)。床单位物体表面消毒合格率伽玛卫生湿巾组(86.67%)优于84消毒剂组(63.33%),差异有统计学意义(P0.05)。三种消毒方法均能有效清除物体表面MRSA。结论消毒湿巾消毒效果可靠,且能有效杀灭新生儿病房床单位物体表面多重耐药菌,适用于新生儿等高风险环境。     

新生儿脐部目标性监测分析

目的研究新生儿脐部细菌定植及感染的危险因素。方法采用目标性监测方法 ,研究新生儿脐部细菌定植及感染情况,并对14项相关危险因素进行单因素和多因素非条件Logistic回归分析。结果 346例新生儿脐部有细菌定植327例,定植率为94.51%,脐部感染39例,感染率11.27%,主要为大肠埃希菌、金黄色葡萄球菌、其他肠道杆菌及耐药菌等,脐带结扎位置、脐带残端长度、脐带直径、脐带贴污染脐部是脐部感染的独立危险因素。结论新生儿脐部易发生细菌定植与感染,控制其危险因素,可预防感染的发生。     

新生儿重症监护病房病原菌分布、耐药性及多重耐药菌感染/定植状况调查

目的通过对新生儿重症监护病房(NICU)患儿病原菌感染/定植状况调查分析,为预防和控制多重耐药菌在医院内传播和临床合理用药提供依据。方法使用实验室信息系统和病历查询系统,实时查阅某院NICU 2009年1月1日至2009年12月30日临床微生物检验报告和病历资料、查房记录。对新生儿监护病房患儿送检各种标本细菌培养及药敏试验结果、临床资料、医院感染危险因素等进行分析。结果革兰阴性菌占73.43%,以大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌为主;革兰阳性菌占26.28%,以金黄色葡萄球菌和表皮葡萄球菌为主;真菌1株,占0.29%。患儿入住NICU时至入NICU 48 h内、48 h后均筛查出多重耐药菌产超广谱β-内酰胺酶(ESBL)的大肠埃希菌、肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌(MRSA),主要以定植菌为主(多数患儿没有感染症状)。结论 ESBLs大肠埃希菌、肺炎克雷伯菌和MRSA是NICU定植和感染的主要多重耐药菌。主动筛查这些多重耐药菌感染和定植状况,第一时间发现多重耐药菌,及时采取消毒隔离措施,切断多重耐药菌传播途径,可降低医院感染发生率。     

B Streptococcus and other pathogenic bacteria colonization in hospitals in the Gdańsk Metro Area

A survey of group B Streptococcus and other pathogenic bacteria colonization was carried out on 658 neonates in 8 neonatal wards of hospitals in the Gdańsk Metro Area and the district of Gdańsk. Out of pathogenic bacteria Haemophilus and enteric bacteria the most frequently were isolated. The percentage of Staphylococcus aureus was relatively low (19.4). The group B Streptococcus frequency in throat was established as 3.8% and ranging from 1.7 to 8.8% in particular wards. In two cases group B streptococcus were not isolated. In probes taken from anus of newborn tested typical enteric flora dominated and E coli and Klebsiella sp were the most frequently encountered. Profile and frequency of bacterial colonization indicated that epidemiological situation in majority of particular wards in similar.     

Recovery of Aerosolized Bacteria from Humans

Environmental factors, especially seasonal, played an important role in the establishment of the neonatal bacterial flora. Staphylococcus aureus colonization decreased and anhemolytic streptococci increased in the autumn. During the summer, Escherichia coli prevalence reached a peak, as did overall colonization. Additional humidity enhanced nasal colonization of Pseudomonas and E. coli. Topical antibacterial agents reduced umbilical colonization of S aureus and S epidermidis but were associated with a "re-bound" or increase in nasal colonization of E coli and Enterobacter. Among premature infants, systemic antibiotics were associated with reduced nasal colonization of S aureus, anhemolytic streptococci, E coli and "other bacilli" and decreased prevalence of S epidermidis and "other bacilli" on the skin. Environmental factors, especially seasonal, should be considered in evaluating bacteriological studies in newborns.     

Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis.

OBJECTIVE: To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU). DESIGN: Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR). SETTING: Level III NICU in a tertiary care center. PARTICIPANTS: Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual. INTERVENTIONS: Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week. RESULTS: Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU. CONCLUSION: An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.     

心脏听诊和经皮脉搏血氧饱和度筛查海南省新生儿先天性心脏病的价值

目的 分析心脏听诊和经皮脉搏血氧饱和度(POX)筛查海南省新生儿先天性心脏病(CHD)的价值.方法 选取2020年1月1日-12月31日在海南省17个市县出生的新生儿作为研究对象,新生儿出生后6～72h内进行常规心脏听诊和POX筛查,筛查阳性的新生儿进行超声心动图以确诊CHD.根据筛查结果,将新生儿分为杂音组(单纯心脏...     

医院环境空气及物表次氯酸雾化消毒效果

目的观察雾化次氯酸形成气溶胶对医院空气及物表微生物的消毒净化效果。方法采用现场消毒试验方法,以500 ml/h的雾化量流速释放次氯酸消毒液,分别消毒前和消毒作用1、3、5、10 min后对环境空气和物体表面进行采样和检测,评价雾化次氯酸的消毒效果。结果以次氯酸进行雾化消毒,分别在消毒1、3、5 min后,空气中的大肠埃希菌、金黄色葡萄球菌、枯草杆菌黑色变种芽孢杀灭率均达到了100.00%;用该次氯酸消毒液对物体表面进行雾化消毒,5 min后木质表面上的大肠埃希菌杀灭率达到了100.00%;消毒10 min后,木质表面上的金黄色葡萄球菌、枯草杆菌黑色变种芽孢杀灭率达到了100.00%。结论通过雾化次氯酸消毒液可快速有效地杀灭空气中及物体表面上的微生物。     

全国71所医疗机构新生儿皮肤消毒剂使用的现况调查

目的 了解全国新生儿护理单元皮肤消毒剂的使用情况。方法 采用便利抽样的方法,于2023年4—5月采用自行设计的调查表调查全国93个新生儿护理单元皮肤消毒剂的使用情况,内容包括消毒剂类型、消毒工具、清洁与消毒次数、消毒剂待干情况、脱消毒剂情况和消毒剂引起的不良反应。结果 共纳入25个省/直辖市71所医疗机构的93个护理单元。新生儿病房中,使用最多的3种消毒剂分别是乙醇(79.57%)、碘伏(74.19%)、安尔碘(62.37%),氯己定在护理单元(<2个月龄婴儿)中的使用情况分别为禁用28个(30.11%),慎用23个(24.73%),可用9个(9.68%),无统一要求33个(35.48%)。13个(17.57%)护理单元使用乙醇时仅擦拭1次,部分护理单元对消毒剂擦拭次数未做统一规定。使用碘伏后,去除残留消毒剂情况,包括29个(42.03%)护理单元使用生理盐水,8个(11.59%)使用乙醇,19个(27.54%)未做统一规定。消毒剂的不良反应主要为皮疹、接触性皮炎,引起不良反应的消毒剂有乙醇、碘伏、安尔碘及氯己定。结论 临床实践中,新生儿皮肤消毒剂使用尚缺乏统一规范,选择和使用差...     

The development of bacterial flora of premature neonates

The sequential acquisition of bacterial flora by premature neonates was studied during a 10 month period. Mean gestational age of the babies was 29.01 weeks and the mean birth weight was 1.728 kg. Escherichia coli and group B streptococci (GBS) colonized the umbilicus of 7 and 6 babies respectively, out of 23 studied, on the first day of life. E. coli and staphylococci were the predominant flora on the 6th day and they colonized 12 and 13 respectively. The oral flora was predominantly Gram-positive cocci, mainly Streptococcus salivarius which was isolated from 17 out of 22 babies on the 6th day, viridans streptococci were isolated from 14 babies, Staphylococcus albus from 16 babies and group D streptococci from 11 babies. Candida spp. also colonized the oral cavities of 17 out of 22 babies on the 6th day. At the end of the first week of life, the faecal flora was predominantly anaerobic represented by Bifidobacterium spp., Bacteroides spp. and Clostridium spp. The commonest facultative faecal flora were E. coli, which was isolated from all the babies, and Strept. faecalis isolated from 20 babies. Early gut colonization by GBS, Bacteroides spp. and Clostridium spp. was noticed in more babies delivered vaginally than by caesarean section where colonization by these bacteria was relatively delayed. The use of prophylactic penicillin plus gentamicin in the special neonatal unit probably prevented systemic spread of any of the potential opportunistic pathogens during the study.     

The development of bacterial flora of premature neonates.

The sequential acquisition of bacterial flora by premature neonates was studied during a 10 month period. Mean gestational age of the babies was 29.01 weeks and the mean birth weight was 1.728 kg. Escherichia coli and group B streptococci (GBS) colonized the umbilicus of 7 and 6 babies respectively, out of 23 studied, on the first day of life. E. coli and staphylococci were the predominant flora on the 6th day and they colonized 12 and 13 respectively. The oral flora was predominantly Gram-positive cocci, mainly Streptococcus salivarius which was isolated from 17 out of 22 babies on the 6th day, viridans streptococci were isolated from 14 babies, Staphylococcus albus from 16 babies and group D streptococci from 11 babies. Candida spp. also colonized the oral cavities of 17 out of 22 babies on the 6th day. At the end of the first week of life, the faecal flora was predominantly anaerobic represented by Bifidobacterium spp., Bacteroides spp. and Clostridium spp. The commonest facultative faecal flora were E. coli, which was isolated from all the babies, and Strept. faecalis isolated from 20 babies. Early gut colonization by GBS, Bacteroides spp. and Clostridium spp. was noticed in more babies delivered vaginally than by caesarean section where colonization by these bacteria was relatively delayed. The use of prophylactic penicillin plus gentamicin in the special neonatal unit probably prevented systemic spread of any of the potential opportunistic pathogens during the study.     

新生儿皮肤黏膜凝固酶阴性葡萄球菌定植高危因素分析

目的 探讨新生儿凝固酶阴性葡萄球菌(CNS)的定植特点及高危因素.方法 对2015年8月至2016年5月在北京妇产医院新生儿重症监护室(NICU)B病区住院的新生儿进行鼻部、眼部、脐带、直肠拭子培养,每周1次;静脉导管移除后管端培养.获取每一个CNS定植新生儿临床资料,同期培养阴性的新生儿作为对照组,采用多元线性回归方法进行高危因素分析.结果 在712名入住NICU的新生儿中,60例(8.4%)新生儿发现CNS定植,中位数天数为8天(四分位差4~13),最常见的CNS定植部位为鼻咽部(n=24),其次是气管插管(n=12).CNS定植单因素分析显示实验组的出生体重及胎龄明显低于对照组(t值分别为-17.501、-11.518,均P<0.05),实验组小儿导管使用率明显高于对照组(χ2值分别为34.751、28.229、14.101、62.484,均P<0.05),但两组性别、子宫下段剖宫产、入院年龄、脐炎的发生情况比较均无统计学意义(均P>0.05).多元线性回归分析显示孕周(P=0.042)、出生体重(P=0.000)、经皮插入的中心导管(CVC)(P=0.006)、口鼻吸引(P=0.011)、呼吸机辅助呼吸(P=0.050)、全肠外营养(P=0.015)是CNS定植的独立高危因素.结论 早产、低出生体重、呼吸机使用、中心静脉置管是CNS定植的高危因素,而频繁口鼻吸引同样应该引起高度重视.     

某三甲医院使用消毒型耦合剂的B超探头微生物污染现状

目的了解使用消毒型耦合剂B超探头的微生物污染现状及存在问题,预防因B超探头引起的医院感染。方法对湖北省某大型三甲医院使用消毒型耦合剂的B超探头进行抽样调查,并对探头污染的细菌进行计数和鉴定,应用SPSS 19.0软件进行统计学分析。结果共采集B超探头样本95份,B超探头样本带菌率为28.42%,合格率为77.89%;不同科室中妇产科B超探头合格率最高,达92.00%,体检中心B超探头合格率最低,仅为38.46%;不同类型的B超探头中套避孕套/无菌手套后的阴道B超探头、心脏B超探头、腹部B超探头、套避孕套/无菌手套前的阴道B超探头的合格率均≥80%,阴道B超探头套避孕套后采样合格率最高(85.71%),B超高频探头合格率最低(57.14%),不同类型B超探头的合格率比较,差异无统计学意义(χ2=6.91,P=0.141);共检出4株MRSA,未检出CRAB。结论使用消毒型耦合剂的B超探头存在一定微生物污染,应提高医务人员的消毒隔离意识,制定相应的清洁消毒制度,定期进行监测和管理。     

Colonization priority among Staphylococcus aureus strains--correlation with phage-type

We have studied the distribution of phage-type patterns among strains of Staphylococcus aureus isolated from patients in a burns unit. From 51 patients the same phage-type was isolated from succeeding swabs during the observation period. In 20 patients new types were introduced, but the original strain remained. In 23 patients the first strain was replaced by one other strain, in eight patients two or more. Strains of type 95 seemed to have a high colonization priority, whereas strains of group III had a low one. In 1986 phage-typing was performed on two or more S. aureus strains from the same patient, in 4561 instances. Recurrence of strains of the same phage-type pattern was demonstrated in 70% of the patients when the first and the fourth sample were compared. The "newer epidemic" strains of phage-type 95 and of the 94,96 complex had the highest percentage of recurrence (more than 80%) when adjacent samples were compared, and 68-69% when the first and the fourth sample were compared. The good colonization capacity of these strains might be one of the explanations why they occur frequently today although they are resistant only to penicillin.     

200例新生儿脐带残端脱落情况比较

目的：探讨临床应用清洁干燥暴露脐带残端以及联合应用3％过氧化氢与0．5%碘伏消毒脐带及脐周，对比其护理效果并进行分析。方法：将200例正常足月新生儿随机分为观察组和对照组各100例。两组分娩过程中脐带结扎方法相同，均在出生后次日晨（出生时间〉12小时）解除脐带护理敷料。观察组采用清洁干燥暴露法护理脐带，对照组联合应用0．5％碘伏与3％过氧化氢消毒脐部。比较两组新生儿脐周皮肤红肿感染情况、脐带残端脱落时间及脐部愈合时间。结果：两组均无脐带感染情况，而观察组脐带残端轻度感染，脐部愈合时间均少于对照组（P〈0．05）。结论：观察组采取脐带清洁干燥暴露法操作简便，缩短脐带残端愈合时间，值得临床推广应用。     

使用中暖箱日常清洁消毒效果评价及对策

目的评价暖箱日常清洁消毒方法的效果,并提出可行的改进办法。方法选择某院 2013年12月-2014年6月新生儿重症监护病房（NICU）30台使用中暖箱,随机分为基线组、对照组和试验组,每组10台。基线组和对照组使用常规消毒法处理,即清水和含氯消毒剂分别擦拭暖箱内外壁,试验组在日常消毒法的基础上加用强化消毒法（乙醇擦拭暖箱内壁）1次,比较各组消毒效果。结果基线组于试验第4天首次检出不合格暖箱,至第7天所有暖箱均发生了不同程度的污染,不合格标本检出率为31.43%（88/280）。对照组首次检出不合格暖箱的时间中位数为第5天,试验组首次检出不合格暖箱的中位数为第7天,两组比较,差异有统计学意义（χ2=12.38,P＜0.05）;试验组标本不合格率为15.36%（43/280）,低于对照组的32.86%（92/280）,两组比较,差异有统计学意义（χ2=23.43,P＜0.05）。结论在常规消毒法的基础上,加用乙醇强化消毒能够有效提高暖箱表面消毒效果,加之其方便实用、经济安全的特点,可以作为暖箱日常消毒方法在基层医疗机构推广使用。