医院多重耐药菌对常用消毒剂抗性的研究

目的观察医院环境分离致多重耐药菌对常用消毒剂抗性。方法选取于2018年1月2日—2018年1月30日于本医院住院患者所用被褥、物品表面和医务人员手部研究对象,检验细菌状况,并进行培养,记录结果。结果铜绿假单胞菌以患者被褥检出率最高(66.67%);肺炎克雷伯杆菌检出以被褥检出率最高(46.67%);鲍曼不动杆菌检出以被褥检出率最高为(60.00%)。铜绿假单胞菌对84消毒液有抗性;肺炎克雷伯杆菌对苯扎溴铵有抗性;鲍曼不动杆菌对84消毒液和苯扎溴铵有抗性。三种致病菌差异有统计学意义(P<0.05)。结论医院环境有多重耐药菌,建议临床依据平时对耐药菌的监测情况,适时调整消毒方案,做好医院环境清洁。     

铜绿假单胞菌对5种消毒剂抗性的研究

目的 了解临床分离的铜绿假单胞菌对碘伏、戊二醛、氯己定、氯氧三嗪(三氯异氰尿酸)和苯扎溴铵5种消毒剂的抗性.方法 采用PhoenixTM-100系统鉴定铜绿假单胞菌和药敏试验,用液体稀释法检测碘伏、戊二醛、氯己定、氯氧三嗪和苯扎溴铵对铜绿假单胞菌的最低抑菌浓度(MIC).结果 190株铜绿假单胞菌对氨苄西林/舒巴坦、氯霉素、四环素、复方新诺明耐药率最高均＞98.0%,几乎已失去对该菌的杀菌能力;而对亚胺培南、美罗培南耐药率较低,仅为15.3%和6.8%,5种消毒剂中,铜绿假单胞菌对戊二醛和氯氧三嗪的抗性最强,MIC50分别为32 μg/ml和64μg/ml;而对氯己定、苯扎溴铵的抗性最弱,MIcso分别为1μg/ml和2.4 μg/ml;氯己定在1 MIC作用10 min,仍能产生快速而强烈的杀菌作用.结论 铜绿假单胞菌对碘伏、戊二醛、氯己定、氯氧三嗪和苯扎溴铵5种消毒剂的抗性差异有统计学意义,应合理使用消毒剂,以降低耐药菌扩散及医院感染发生.     

包装饮用水中铜绿假单胞菌污染状况调查研究

目的开展包装饮用水生产过程中铜绿假单胞菌污染状况的调查,针对性地提出控制措施。方法采用国家标准方法,对湖北省地区15家包装饮用水生产企业的水源水、过程水、成品水及包装容器等共计116份样品进行铜绿假单胞菌及常规微生物的检测。结果精滤后水、活性炭过滤后水、石英砂过滤后水和水源水受铜绿假单胞菌的污染较为严重,检出率分别为66. 7%、66. 7%、46. 7%、40. 0%。铜绿假单胞菌阳性菌株主要为产绿脓菌素的黄绿色菌落形态,占阳性菌株的比例为79. 2%。大肠菌群的合格率与铜绿假单胞菌检出率比较,差异有统计学意义(χ2=13. 901,P 0. 01)。结论包装饮用水在生产过程中存在铜绿假单胞菌的污染,企业应加强对设备、管道、储罐等清洁消毒,同时监管部门应加强对包装饮用水生产过程的监管。     

桶装饮用水灌装间铜绿假单胞菌污染状况及消毒方法

目的分析灌装间的铜绿假单胞菌污染情况并研究适宜的消毒方法,以降低铜绿假单胞菌污染风险,提高产品质量。方法调查分析周边43家企业的桶装饮用水灌装间及其他主要生产环节的铜绿假单胞菌污染情况,以取水样、擦拭等方式对灌装间及其他生产环节进行取样分析;采用悬液定量试验方法研究不同浓度、不同作用时间下过氧化氢对铜绿假单胞菌的杀灭效果;并用5 g/L的过氧化氢溶液以喷洒方式验证现场消毒效果。结果灌装间的铜绿假单胞菌污染情况较严重。过氧化氢杀灭铜绿假单胞菌试验表明,0.4 g/L过氧化氢溶液作用20 s即可杀灭50.04%的铜绿假单胞菌;用5 g/L过氧化氢通过喷洒的方式对存在铜绿假单胞菌污染的灌装间消毒,连续3批次未检出铜绿假单胞菌。结论过氧化氢对铜绿假单胞菌有较强杀灭作用,能有效消除铜绿假单胞菌污染,对灌装间消毒效果较好。     

成都市生活饮用水中铜绿假单胞菌的污染调查

为了解成都市生活饮用水中铜绿假单胞菌的污染情况,于2012年采集成都市城区内生活饮用水样进行检测。结果显示,共检测水样756件,检出铜绿假单胞菌21株,检出率为2.8%。管网水的检出率为0.4%,二次供水的检出率为6.4%,二次供水中铜绿假单胞菌的检出率[6.4%(19/296)]高于管网水[0.4%(2/460)],差异有统计学意义(P0.05);不同季节二次供水和管网水中铜绿假单胞菌的检出率间比较,差异无统计学意义(均P0.05)。提示成都市生活饮用水存在铜绿假单胞菌污染,且以二次供水较为严重。     

桶装天然矿泉水铜绿假单胞菌污染原因调查

[目的] 调查某企业桶装天然矿泉水铜绿假单胞菌的污染原因。[方法] 对桶装天然矿泉水进行检验,以肉汤增菌法,通过MPN计算铜绿假单胞菌的数量。[结果] 水源水通过水处理系统直至灌装环节的细菌学指标未见异常,但包装材料洗涤用水自蓄水池水开始出现微生物污染,菌落总数超标并均检出铜绿假单胞菌。[结论] 该企业半露天的蓄水池水是原始污染源,企业用蓄水池水洗刷大桶及车间地面,导致包装材料被交叉污染。厂家停用蓄水池,已无铜绿假单胞菌污染。     

徐州市市区小学饮水机桶装水铜绿假单胞菌污染监测与溯源

目的 调查小学饮水机水中铜绿假单胞菌污染情况。方法 2015年10月采集徐州市市区5所小学50个饮水机内的水样50份,按照《2015年江苏省食品微生物及其致病因子监测工作手册》中《铜绿假单胞菌检验标准操作程序》进行检测。结果 铜绿假单胞菌检出率为24.00%(12/50);定量结果最高为510 cfu/mL,最低为1 cfu/mL;合格率为76.00%(38/50)。同一学校不同饮水机检出的2株铜绿假单胞菌的相似系数为100.00%,距离相近学校检出的铜绿假单胞菌相似系数达60.00%～80.00%;距离相对较远的学校饮水机中检出的铜绿假单胞菌相似系数为60.00%;不同学校检出的铜绿假单胞菌比同一所学校不同饮水机水检出的铜绿假单胞菌相似系数高;不同学校检出的铜绿假单胞菌的同源性比同一所学校不同的桶装水检出的铜绿假单胞菌相似系数高。结论 小学饮水机桶装水中有铜绿假单胞菌污染,应提高中小学生桶装水卫生知识,并定期对饮水机进行消毒,建立监管制度,防止校园内学生腹泻疾病的发生。     

食品中铜绿假单胞菌的监测分析

目的了解食品受铜绿假单胞菌污染的程度,为开展食品监测、防止食品污染提供指导。方法采用标准SN/T2099—2008和GB/T 8538—2008中4.54铜绿假单胞菌的检测方法,对熟肉制品、凉拌即食食品、饮用水3类产品进行监测。结果发现3类产品受铜绿假单胞菌污染程度不同,其中熟肉制品检出率为6.25%、凉拌即食食品检出率为17.65%,饮用水的检出率为1.19%,可以看出熟肉制品和凉拌即食食品比较容易受铜绿假单胞菌污染。绿脓素作为铜绿假单胞菌的特征指标,可以在检测中指示铜绿假单胞菌的检出。结论产品本身在生产销售环节容易受铜绿假单胞菌污染,有必要对该菌进行风险监测,以提高产品质量,降低该菌所引起的食品污染带来的风险。     

大理州桶装饮用水中铜绿假单胞菌污染情况调查

目的了解大理州桶装饮用水卫生微生物及铜绿假单胞菌的污染情况及饮水机造成的污染状况,为桶装饮用水的食品安全措施控制提供依据。方法根据《云南省食品安全风险监测工作手册》确定检测方法。按照GB/T 8538—2008《饮用天然矿泉水检验方法》进行监测。结果 2014年-2015年对大理州内各个桶装水品牌的送水销售服务站的66份桶装水进行监测,铜绿假单胞菌检出率为6.06%;卫生微生物指标合格率为25.76%。检出铜绿假单胞菌与未检出铜绿假单胞菌的卫生指标合格率分别为25.00%、25.81%。未经过和经过饮水机的桶装饮用水的卫生微生物指标超标率分别为53.85%、87.50%;铜绿假单胞菌检出率分别为3.85%、7.50%。结论此次监测的桶装饮用水存在卫生微生物指标合格率较低,致病性铜绿假单胞菌有较高检出率的问题。桶装水产品的监管需要加强,同时饮水机消毒规范制定及监管也是保障桶装水饮水安全不可或缺的措施。     

金山区中小学校学生饮用水铜绿假单胞菌污染状况调查

目的了解金山区中小学校学生饮用水铜绿假单胞菌污染状况,探索方便、卫生、适宜的饮水模式。方法采用分层随机抽样的方法抽取直饮水学校12家和桶装水学校14家,在2016年采集直饮水24份,经饮水机桶装水29份和同批次未开封的桶装水29份,开展铜绿假单胞菌检测。结果金山区中小学校供学生饮用水铜绿假单胞菌检出率为16.98%,桶装水和直饮水铜绿假单胞菌检出率差异有统计学意义(P0.05);经饮水机桶装水铜绿假单胞菌检出率为31.03%,未经饮水机桶装水检出率为6.90%,差异有统计学意义(P0.05)。结论学生在校饮用水直饮水铜绿假单胞菌污染状况优于桶装水,饮水机为桶装水铜绿假单胞菌污染的主要原因,建议加强管理、监督和监测。     

医院感染病原菌对3种消毒剂抗力的研究

目的了解医院感染4种常见病原菌对医院常用的3种消毒剂的抗力水平。方法采集培养鉴定医院感染患者的病原菌,用实验室消毒定量杀菌方法,测定病原菌的抗力水平。结果医院感染常见的病原菌为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌等,从医院感染病例分离出的铜绿假单胞菌对有效氯消毒剂的抗力低于标准菌株(ATCC15442);金黄色葡萄球菌对3种消毒剂的抗力均低于标准菌株(ATCC6538);肺炎克雷伯菌对碘伏和有效氯消毒剂的抗力低于标准菌株(ATCC46117);大肠埃希菌对3种消毒剂的抗力与标准菌株(8099)的差异无统计学意义(P>0.05)。结论医院感染常见的病原菌对常用消毒剂的抗力水平研究应引起关注。     

3种消毒剂对早产儿暖箱消毒效果及适用性比较

目的寻找早产儿培养箱安全、有效的消毒剂。方法试验在母婴同室内,同等环境下进行,随机将培养箱分为A、B、C 3组,A组:用含250 mg/L"84"含氯消毒液配制的溶液擦拭箱体、操作窗、贮水口、床垫;B组:用含500mg/L络合碘液擦拭,部位同A组;C组:用0.1%苯扎溴铵溶液,擦拭部位同A组,比较3组消毒剂消毒效果。结果 3种消毒方法对有机玻璃罩内壁消毒的有效率分别为92.00%、96.77%及87.51%,对贮水口消毒的有效率分别为82.35%、92.59%及90.63%,对床垫消毒的有效率分别为93.33%、92.31%及89.36%,对操作窗消毒的有效率分别为94.23%、95.35%及91.07%,消毒前后检出的菌落数比较,差异有统计学意义(P<0.05),说明3种消毒剂能达到消毒效果;3种消毒剂消毒后两两相比较,差异无统计学意义。结论 "84"含氯消毒液、聚维酮碘、0.1%苯扎溴铵溶液3种消毒剂相比较,聚维酮碘毒性低、无刺激性,性能稳定,更适合使用中暖箱消毒。     

Contribution of tap water to patient colonisation with Pseudomonas aeruginosa in a medical intensive care unit

This study examined tap water as a source of Pseudomonas aeruginosa in a medical intensive care setting. We prospectively screened specimens of patients, tap water and hands of healthcare workers (HCWs) over a six-month period in a 16-bed medical intensive care unit. Molecular relatedness of P. aeruginosa strains was investigated by pulsed-field gel electrophoresis. A total of 657 tap water samples were collected from 39 faucets and 127 hands of HCWs were sampled. P. aeruginosa was found in 11.4% of 484 tap water samples taken from patients' rooms and in 5.3% of 189 other tap water samples (P<0.01). P. aeruginosa was isolated from 38 patients. Typing of 73 non-replicate isolates (water samples, hands of HCWs and patients) revealed 32 major DNA patterns. Eleven (52.4%) of the 21 faucets were contaminated with a patient strain, found before isolation from tap water in the corresponding room in nine cases, or from the neighbouring room in two cases. Among seven P. aeruginosa strains isolated from HCW hands, the genotype obtained was the same as that from the last patient they had touched in six cases, and in the seventh with the last tap water sample used. More than half of P. aeruginosa carriage in patients was acquired via tap water or cross-transmission. Carriage of P. aeruginosa by patients was both the source and the consequence of tap water colonisation. These results emphasise the need for studies on how to control tap water contamination.     

Microbial contamination of nebulizers in the home treatment of cystic fibrosis

BACKGROUND: Home nebulizers are in widespread use in cystic fibrosis (CF) and other chronic pulmonary diseases. Bacterial contamination may be a source of respiratory tract colonization. OBJECTIVES: To investigate microbial contamination of home nebulizers in CF patients, compare with sputum cultures and relate to cleaning practices. METHODS: A total of 29 home nebulizers of CF patients were cultured. Families were interviewed regarding cleaning routines and patients had sputum cultures for bacteria and fungi. RESULTS: In total, 19/29 (65%) nebulizers were contaminated: 18 reservoir cups, 14 mouthpieces and five filters. Pseudomonas spp. were isolated from 10 nebulizers (35%) and all 10 had Pseudomonas aeruginosa airway infection although without genetic typing we could not be sure this was the same bacteria as that from their nebulizer unit. An additional 7/29 had Pseudomonas aeruginosa airway infection without a contaminated nebulizer (P=0.001). No nebulizers were contaminated with Aspergillus. Only 4/19 contaminated nebulizers (22%) had been cleaned after every use, compared with seven of the 10 (70%) uncontaminated nebulizers (P=0.017). Only 7/19 patients with contaminated nebulizers (37%) and 5/10 with clean nebulizers (50%) recalled receiving cleaning instructions (not significant). CONCLUSIONS: Home nebulizers are frequently contaminated, particularly when cleaning instructions are inadequate, and may be a source of airway infection or reinfection especially following contamination from a patient chronically colonized with P. aeruginosa. Simple oral and written cleaning instructions should be offered.     

2015 - 2017年镇江市食源性致病菌监测结果分析

目的 了解2015 - 2017年镇江市食品中食源性致病菌污染情况,为食品安全风险评估和监督管理提供依据。方法 依据《国家食品污染物和有害物质因素风险监测工作手册》中的操作标准,对食品中铜绿假单胞菌、金黄色葡萄球菌、单核细胞增生李斯特菌、沙门菌、副溶血性弧菌、创伤弧菌、霍乱弧菌和蜡样芽胞杆菌8种食源性致病菌进行检测。结果 2015 - 2017年监测的748份样品中, 检出阳性致病菌101株,总体检出率为13.50%。所采样品中检出最多的是副溶血性弧菌（检出率18.21%）和铜绿假单胞杆菌（阳性率14.52%）;主要污染的食品类别为水产品（检出率36.00%）和直饮水（30.00%）;企业单位（检出率40.00%）和农贸市场（检出率29.91%）的食品致病菌污染相对较多。2015 - 2017年食源性致病菌检出率分别29.01%、15.79%、12.24%。结论 镇江地区食源性致病菌阳性检出率虽逐年下降,但仍存在一定程度的致病菌污染。今后还需进一步加强风险监测力度,为本市的食品安全和广大群众的身体健康提供有力保障。     

Pseudomonas aeruginosa and Pseudomonas putida outbreak associated with contaminated water outlets in an oncohaematology paediatric unit

This paper describes an outbreak of Pseudomonas aeruginosa and Pseudomonas putida that occurred in an oncohaematology paediatric unit between January and April 2005. Eight children had nosocomial infections due to P. aeruginosa (N=5) or P. putida (N=3), which were recovered from central venous catheter blood cultures (N=4), the catheter exit site alone (N=2), or the catheter exit site and the catheter tip (N=2). Subsequent investigation showed that contaminated water outlets represented the possible source of spread. Studies of nursing and environmental cleaning practices revealed two modes of catheter contamination. A reduction in the size of the catheter dressing at the exit site gave less protective cover during showers, and a detergent-disinfectant diluted with tap water had contaminated perfusion bottles. Repetitive intergenic consensus polymerase chain reaction indicated two discrete patterns for P. aeruginosa and one for P. putida. The water network was chlorinated, and disposable seven-day filters were fitted on all taps and showers. Due to the deleterious effects of chlorination on the water network and the cost of the weekly filter change, a water loop producing microbiologically controlled water was installed. In addition, the concentration of the detergent-disinfectant was increased and refillable sprayers were replaced with ready-to-use detergent-disinfectant solution for high-risk areas. Following these measures, no Pseudomonas spp. have since been isolated in clinical or environmental samples from the ward.     

Testing for aerobic heterotrophic bacteria allows no prediction of contamination with potentially pathogenic bacteria in the output water of dental chair units

Background: Currently, to our knowledge, quality of output water of dental chair units is not covered by specific regulations in the European Union, and national recommendations are heterogeneous. In Germany, water used in dental chair units must follow drinking water quality. In the United States of America, testing for aerobic heterotrophic bacteria is recommended. The present study was performed to evaluate whether the counts of aerobic heterotrophic bacteria correlate with the presence of potentially pathogenic bacteria such as Legionella spp. or Pseudomonas aeruginosa. Methods: 71 samples were collected from 26 dental chair units with integrated disinfection device and 31 samples from 15 outlets of the water distribution pipework within the department were examined. Samples were tested for aerobic heterotrophic bacteria at 35°C and 22°C using different culture media and for Legionella spp. and for Pseudomonas aeruginosa. Additionally, strains of Legionella pneumophila serogroup 1 were typed with monoclonal antibodies and representative samples of Legionella pneumophila serogroup 1 were typed by sequence based typing.Results: Our results showed a correlation between different agars for aerobic heterotrophic bacteria but no correlation for the count of aerobic heterotrophic bacteria and the presence of Legionella spp. or Pseudomonas aeruginosa.Conclusion: Testing for aerobic heterotrophic bacteria in output water or water distribution pipework within the departments alone is without any value for predicting whether the water is contaminated with potentially pathogenic bacteria like Legionella spp. or Pseudomonas aeruginosa.