山东省沐浴场所淋浴水中嗜肺军团菌污染状况及耐药性调查  

Investigation of legionella pneumophila contamination and antibiotic resistance in shower water at bathing venues in Shandong Province

作　　者：江媛媛[1] 高衍新[1] 隋少峰 杜英林[1] 张晓[1] 胡彬[3] 董非[2] JIANG Yuan-yuan;GAO Yan-xin;SUI Shao-feng;DU Ying-lin;ZHANG Xiao;HU Bin;DONG Fei(Shandong Provincial Center for Disease Control and Prevention,Health Inspection and Testing Institute,Jinan,Shandong 250014,China;不详)

机构地区：[1]山东省疾病预防控制中心公共卫生监测评价所,山东济南250013 [2]山东省疾病预防控制中心消毒与病媒生物防治所,山东济南250013 [3]山东省疾病预防控制中心卫生检验检测所,山东济南250014 [4]上海市疾病预防控制中心健康危害因素监测与控制所

出　　处：《现代预防医学》2025年第5期916-921,共6页Modern Preventive Medicine

基　　金：山东省自然科学基金面上项目(ZR2022MH318);山东省医药卫生科技项目(202312011009)。

摘　　要：目的 调查山东省沐浴场所淋浴水中嗜肺军团菌(Legionella pneumonia,Lp)的污染状况、影响因素以及对抗生素的耐药性,为制定人群Lp感染的防控策略提供科学依据。方法 于2020-2022年以整群随机抽样的方法在山东省内16个城市每年抽取2~3家公共沐浴场所,进行淋浴水中Lp的检测。按照淋浴水样采集时间、水箱大小、供水方式、水箱是否消毒等分层探讨Lp检出率的影响因素;对阳性样品中的Lp进行血清分型及抗生素耐药性检测,进一步分析Lp抗生素耐药性特点。结果 在采集的143份样品中,有55份Lp检测阳性,阳性率为38.5%。血清学分型鉴定发现,阳性Lp血清1型(LP1)占比51%。不同的水样采集时间(10月份为46.7%,4月份为29.4%,χ^(2)=4.49,P<0.05)、不同供水水箱储水量(水箱储水量大于日用水量者为50.8%,水箱储水量小于日用水量者为18.2%,χ^(2)=10.39,P<0.01)及不同水样采集位置(管网入水口为26.5%,淋浴喷头为44.7%,χ^(2)=4.48,P<0.05)等对淋浴水中Lp的检出率有影响,三种不同分组比较的组内差异均有统计学意义。分离出的55株阳性菌株对7种一线治疗药物表现为不同程度的耐药,对头孢呋辛的耐药率最高,为90.9%,对阿奇霉素耐药率最低,为14.5%。结论 山东省16个城市沐浴场所淋浴水中Lp阳性率的高低主要受环境温度和淋浴水在供水系统中滞留的影响,环境中Lp主要是对头孢呋辛、利福平、舒巴坦等抗生素耐药,建议加强对淋浴水的监管,关注菌群耐药性变化,保障公共场所淋浴用水安全,保护人民群众的身体健康。Objective To investigate the contamination levels of Legionella pneumophila(Lp)in shower water at bathing venues in Shandong Province,the influencing factors,and antibiotic resistance,providing a scientific basis for formulating prevention and control strategies for Lp infections in the population.Methods Using a cluster random sampling method,2 to 3 public bathing venues were selected annually from 16 cities in Shandong Province from 2020 to 2022 for testing Lp in shower water.The influencing factors on the detection rate of Lp were explored based on the time of water sample collection,the size of water tanks,water supply methods,and whether the tanks were disinfected.Serotyping and antibiotic resistance testing were conducted on positive samples to further analyze the characteristics of antibiotic resistance in Lp.Results Among the 143 samples collected,55 tested positives for Lp,yielding a positivity rate of 38.5%.Serological typing identified that serotype 1(LP1)accounted for 51%of the positive Lp strains.The detection rate of Lp was influenced by various factors,including different water sample collection times(46.7%in October,29.4%in April,χ^(2)=4.49,P<0.05),varying water tank storage capacities(50.8%for tanks with a capacity greater than daily water usage,18.2%for those with a capacity less than daily usage,χ^(2)=10.39,P<0.01),and different sampling locations(26.5%at the water inlet of the pipeline,44.7%at the showerhead,χ^(2)=4.48,P<0.05),with statistically significant differences observed within the groups.The 55 positive strains exhibited varying degrees of resistance to seven first-line treatment antibiotics,with the highest resistance rate to cefuroxime(90.9%)and the lowest to azithromycin(14.5%).Conclusion The positivity rate of Lp in shower water at bathing venues across 16 cities in Shandong Province is primarily influenced by environmental temperature and the retention of shower water in the water supply system.The Lp strains in the environment show significant resistance to antibiotics such as

关 键 词：嗜肺军团菌 沐浴场所 淋浴水 耐药性 

分 类 号：R123.1[医药卫生—环境卫生学] R378.99[医药卫生—公共卫生与预防医学]