医院空调回风口滤网积尘中抗生素抗性基因污染的比较  

Comparison of antibiotic resistance genes contamination in the dust on the return vent filters of air-conditioners in Wuhan hospital

作　　者：邱婉月 夏雨荷 龚林[3] 袁凤云 陈琪 李家豪 梁建生[3] 唐非[1] QIU Wan-yue;XIA Yu-he;GONG Lin;YUAN Feng-yun;CHEN Qi;LI Jia-hao;LIANG Jian-sheng;TANG Fei(Institute of Environmental Medicine,Ministry of Education Key Laboratory of Environment and Health,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Hubei Provincial Center for Disease Prevention and Control,Wuhan 430079,China;Department of Disinfection and Pest Control,Wuhan Centers for Disease Prevention and Control,Wuhan 430015,China;Jiang'an District Center for Disease Prevention and Control,Wuhan 430010,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院环境医学研究所,环境与健康教育部重点实验室,湖北武汉430030 [2]湖北省疾病预防控制中心,湖北武汉430079 [3]武汉市疾病预防控制中心消毒与病媒生物防制所,湖北武汉430015 [4]武汉市江岸区疾病预防控制中心,湖北武汉430010

出　　处：《中国环境科学》2022年第5期2321-2330,共10页China Environmental Science

摘　　要：为了解医院环境中抗生素抗性基因(ARGs)的污染情况与分布特征,于2018年11月至2021年4月期间分批次采集了武汉市两家医院部分病房空调回风口滤网积尘样本127份,对其进行β-内酰胺类ARGs(mecA、bla_(TEM)、bla_(CTX-M)、bla_(SHV))和碳青霉烯类ARGs(bla_(KPC)、bla_(NDM-1)、bla_(IMP)、bla_(VIM)、bla_(OXA-51))及一类整合酶基因intI 1的定性与定量检测与评价.结果表明,医院不同科室及ICU空调滤网积尘中可检出以上9种β-内酰胺类,碳青霉烯类ARGs及intI 1,平均检出率分别为55.12%、37.64%和81.89%.ICU的β-内酰胺类与碳青霉烯ARGs的平均检出率显著高于外科与内科(P<0.05);4种β-内酰胺类ARGs中的bla_(TEM)、mecA检出率及其相对丰度在内科、外科最高(P<0.05);ICU的bla_(SHV)检出率及其相对丰度高于内科、外科(P<0.05).5种碳青霉烯类ARGs中的bla_(NDM-1)检出率及其相对丰度在内科、外科显著高于bla_(KPC)、bla_(IMP)(P<0.05).intI 1与9种ARGs的相对丰度均呈显著正相关(P<0.05).研究结果表明,两家医院不同科室病房空调滤网积尘中存在β-内酰胺类和碳青霉烯类ARGs以及一类整合酶基因intI 1的污染,内科、外科、ICU均以bla_(TEM)、mecA、bla_(NDM-1)为主,由此可认为医院不同科室空气及相关环境中可能存在与此等ARGs相关的耐甲氧西林金黄色葡萄球菌、产ESBLs肠杆菌科细菌、耐碳青霉烯大肠埃希菌与鲍曼不动杆菌等耐药菌的现时与既往污染,并且存在ARGs水平转移的风险;ICU空调滤网积尘中β-内酰胺类与碳青霉烯ARGs的污染较内科、外科严重,其中bla_(SHV)污染高于内科、外科,由此表明,ICU是ARGs及相关耐药菌污染的高风险科室.The objective of this study was to explore the contamination and disstrubution characteristics of antibiotic resistance genes(ARGs)in hospital environment.From November 2018 to April 2021,127 dust samples on return vent filters from air-conditioners in different wards of 2 Wuhan hospitals were collected in multiple batches for qualitative and quantitative determination ofβ-lactam ARGs(mecA,bla_(TEM),bla_(CTX-M),bla_(SHV)),carbapenem ARGs(bla_(KPC),bla_(NDM-1),bla_(IMP),bla_(VIM),bla_(OXA-51))and class 1integrase gene(intI1).Nine types of abovementioned ARGs and intI1were found in dust samples from different departments,with the average detection rates of 55.12%,37.64%and 81.89%forβ-lactam ARGs,carbapenem ARGs and intI1respectively.The average detection rate ofβ-lactam and carbapenem ARGs in ICU were significantly higher than in departments of internal medicine and surgery(P<0.05);The detection rate and relative abundance of bla_(TEM) and mecA were highest in departments of internal medicine and surgery among the 4types ofβ-lactam ARGs,(P<0.05);the detection rate and relative abundance of bla_(SHV) in ICU were higher than in other departments(P<0.05).Significantly higher detection rate and relative abundance were observed for bla_(NDM-1) than for bla_(KPC) and bla_(IMP)among the 5 types of carbapenem ARGs in departments of internal medicine and surgery.(P<0.05).There was a significant positive correlation between intI1and 9 types of ARGs(P<0.05).This study confirmed the contamination ofβ-lactam ARGs,carbapenem ARGs and intI1in dusts retaining on the return vent filters of air-conditioners in 2hospitals,where bla_(TEM),mecA and bla_(NDM-1) prevailed in ICUs and departments of internal medicine and surgery.Accordingly it was suggested that there may be past and ongoing contamination and concomitant risk of horizontal transfer of ARGs among drug-resistant bacteria,such as MRSA,ESBLs-producing Enterobacteriaceae bacteria,carbapenem-resistant Escherichia coli and Acinetobacter baumannii,in air and relevant hospita

关 键 词：医院 空调滤网 积尘 抗生素抗性基因 耐药菌 

分 类 号：X172[环境科学与工程—环境科学] R122[医药卫生—环境卫生学]