重症监护病房医务人员鼻前庭细菌定植情况及耐药性调查

目的了解重症监护病房（ICU）医务人员鼻前庭病原菌定植情况，为加强ICU医院感染的预防与控制提供依据。方法2015年5月主动筛查某院ICU非感染状态下的医务人员鼻前庭细菌定植情况，并进行细菌培养、菌株分离及菌种鉴定。分析调查结果并与同期患者检出细菌的耐药情况进行比较。结果共调查医务人员96名，从鼻前庭标本中分离病原菌43株，分别来自不同的医务人员，病原菌分离率及携带率均为44.79%。分离的主要病原菌为金黄色葡萄球菌（15株，占34.88%），其次为产气肠杆菌（9株，占20.93%）、肺炎克雷伯菌（7株，占16.28%）等。医生、经常吸烟及从不锻炼的医务人员鼻前庭病原菌的检出率较高，差异具有统计学意义（均P＜0.05）。43株病原菌中检出1株耐亚胺培南的肺炎克雷伯菌。医务人员检出的7株肺炎克雷伯菌对氨苄西林/舒巴坦、头孢唑林、呋喃妥因的耐药率均＞50.00%，对头孢噻肟与亚胺培南的耐药率分别为28.57%、14.29%；同期患者检出的11株肺炎克雷伯菌对呋喃妥因的耐药率为100.00%，对其他常用抗菌药物均敏感。医务人员检出的4株大肠埃希菌对氨苄西林的耐药率为75.00%，对庆大霉素、妥布霉素、左氧氟沙星、环丙沙星及复方磺胺甲口恶唑的耐药率均为50.00%，而同期患者检出的6株大肠埃希菌对大部分常用抗菌药物均耐药。结论长期工作在ICU的医务人员鼻前庭病原菌定植率高，定期主动对医务人员鼻前庭病原菌定植情况进行筛查及监测，对预防医院感染，防止医务人员与患者之间的交叉传播具有重要意义。

Colonization and antimicrobial resistance of pathogens in nasal vestibular of health care workers in intensive care unit

ObjectiveTo understand colonization of pathogens in nasal vestibular of health care workers (HCWs) in intensive care unit(ICU), and provide evidence for strengthening the prevention and control of healthcare associated infection (HAI) in ICU. MethodsOn may 2015, colonization status of pathogens in nasal vestibular of uninfected HCWs in ICU were actively screened, bacterial culture, isolation and identification were performed. The surveyed results were analyzed and compared with antimicrobial resistance of pathogens from patients at the same stage. ResultsA total of 96 HCWs were surveyed, 43 pathogenic strains were isolated from different HCWs’ nasal vestibular, isolation rate and carriage rate were both 44.79%. The main pathogenic bacteria was Staphylococcus aureus(n=15， 34.88%）, followed by Enterobacter aerogenes(n=9， 20.93%） and Klebsiella pneumoniae(K. pneumoniae, n=7，16.28%）. There was a high detection rate of pathogens from nasal vestibular of doctors, HCWs who smoked frequently and those who never exercised (all P<0.05). There were 1 strain of imipenem resistant K. pneumoniae among 43 pathogenic strains. Resistance rate of 7 K. pneumoniae from HCWs to ampicillin/sulbactam, cefazolin, and furantoin were all >50.00%, resistance rates to cefotaxime and imipenem were 28.57% and 14.29% respectively； resistance rates of 11 strains of K. pneumoniae from patients to furantoin was 100.00% during the same stage, but were sensitive to other commonly used antimicrobial agents. Resistance rate of 4 strains of Escherichia coli (E. coli)to ampicillin was 75.00%, to gentamicin, tobramycin, levofloxacin, ciprofloxacin, and compound sulfamethoxazole were all 50.00%， 6 strains of E. coli isolated from patients during the same period were found to be resistant to most commonly used antimicrobial agents. ConclusionColonization rate of pathogens is high in nasal vestibular of HCWs in ICU, active screening and monitoring on colonization of pathogens in HCWs’ nasal vestibular is significant for preventing the occurrence and cross transmission of HAI among HCWs and patients.