医院水环境中碳青霉烯类耐药细菌多样性及耐药基因  

Research on diversity and drug resistance genes of carbapenem resistant bacteria in hospital water environment

作　　者：史庆丰 王志翔[2] 鲍容 王苏珍 崔扬文 胡必杰 高晓东 SHI Qing-feng;WANG Zhi-xiang;BAO Rong;WANG Su-zhen;CUI Yang-wen;HU Bi-jie;GAO Xiao-dong(Zhongshan Hospital of Fudan University,Shanghai 200032,China;不详)

机构地区：[1]复旦大学附属中山医院感染管理科,上海200032 [2]宁夏回族自治区人民医院医院感染管理科,宁夏银川750001 [3]复旦大学附属中山医院检验科,上海200032 [4]复旦大学附属中山医院感染病科,上海200032

出　　处：《中华医院感染学杂志》2022年第4期605-609,共5页Chinese Journal of Nosocomiology

基　　金：复旦大学附属中山医院院内课题基金资助项目(2019ZSQN60、2020ZSQN33)。

摘　　要：目的 调查医院内不同水环境中碳青霉烯类耐药细菌的分布及其耐药基因携带现状。方法 使用mSuper CARBA显色平板(含美罗培南4μg/ml)对医院门诊区域、普通病房、行政楼和重症监护室的洗手池、拖把清洗和废液倾倒处水槽孔进行采样,培养48 h后使用MALDI-TOF质谱仪对细菌进行鉴定。同时使用数字聚合酶链式反应(PCR)微滴法对所采水环境样本进行碳青霉烯耐药基因bla、bla、bla、bla鉴定。结果共采集71个水环境样本,49个占69.01%样本培养出碳青霉烯类耐药细菌,以嗜麦芽寡养单胞菌的检出率最高为43.66%(31/71),其次为鲍氏不动杆菌15.49%(11/71);39份水环境样本可鉴定出至少1种耐药基因,其中bla检出率显著高于其他三个耐药基因(P=0.001),9份细菌培养阴性样本可鉴定出bla或bla耐药基因。结论 医院水环境中广泛定植碳青霉烯类耐药细菌,重症监护室(ICU)和普遍病房水环境bla耐药基因污染严重,可能成为医院感染多药耐药菌来源,今后应加强对此类环境的消毒管理。OBJECTIVE To investigate the distribution and drug resistance genes of carbapenem resistant bacteria in different water environment of hospital. METHODS Samples from sink holes of hand washing basin, mop cleaning and waste liquid dumping in outpatient area, general ward, administration building and intensive care unit were collected on MSuper CARBA chromotropic medium plate(containing meropenem 4 μg/ml) and cultured for 48 h for the identification of the positive-cultured bacteria by MALDI-TOF mass spectrometer. Digital PCR micro drop method was used to identify the carbapenem resistance genes bla, bla, blaand bla. RESULTS A total of 71 water environment samples were collected, and 49(69.01%) samples were resistant to carbapenem. The detection rate of Stenotrophomonas maltophilia was the highest(43.66%, 31/71), followed by Acinetobacter baumannii(15.49%, 11/71). At least one resistance gene in 39 water environment samples could be identified. And the detection rate of blaresistance gene was significantly higher than the other three resistance genes(P=0.001). In addition, blaor blaresistance genes were identified in 9 negative bacterial culture samples. CONCLUSION Carbapenem resistant bacteria are widely colonized in hospital water environment, and blaresistance gene spread over large areas, such in ICU and general ward water environment, and may become the source of hospital multi-drug-resistant bacteria. Therefore, The disinfection management of such environment should be strengthened in the future.

关 键 词：水环境 病原菌 碳青霉烯类耐药 耐药基因 重症监护室 

分 类 号：R123[医药卫生—环境卫生学]