不同专科ICU碳青霉烯耐药革兰阴性菌分布特征的调查研究

doi:10.3761/j.issn.2096-7446.2025.05.003

摘要/Abstract

摘要：

目的分析不同专科ICU中碳青霉烯耐药革兰阴性菌（carbapenem-resistant organism，CRO）的分布特点，为采取专科疾病特色的感染控制措施提供依据。方法 2023年9月—11月，于浙江省杭州市某三级甲等综合医院4个院区，10个专科ICU和6个普通病区进行采样。随机采集护理人员的手部和环境物表的样本。利用美罗培南筛选CRO菌株，并对所有CRO菌株进行同源性分析。结果共采集1 170份样本，包括护理人员手部334份和环境物表836份。共检出209株CRO菌株，CRO携带率为17.9%，烧伤ICU携带率最高，为44.0%。其中碳青霉烯耐药鲍曼不动杆菌、碳青霉烯耐药肺炎克雷伯菌、碳青霉烯耐药阴沟肠杆菌和碳青霉烯耐药铜绿假单胞菌占比分别为67.9%、14.8%、11.0%和6.2%。同源性分析显示，ICU内物表检出的菌株存在克隆传播现象，其中有3个ICU还存在“手部-物表”之间的传播，但未发现跨科室和跨院区传播。结论不同专科ICU CRO主要为鲍曼不动杆菌，ICU同一科室内CRO菌株的克隆传播较为普遍，包括“环境-物表”和“手部-物表”之间的传播，提示护理管理者应加强多重耐药菌集束化管理的规范化落实。

关键词: 重症监护病房, 碳青霉烯耐药, 革兰阴性菌, 医院感染, 护理管理

Abstract:

Objective To analyze the distribution characteristics of carbapenem-resistant gram-negative organisms （CRO） in ICU wards of different specialties，and to provide a basis for adopting infection control measures with characteristics of specialty diseases. Methods From September 2023 to November 2023，samples were collected from 4 hospital districts，10 specialized ICUs and 6 general wards of a comprehensive tertiary general hospital in Hangzhou，Zhejiang Province. Random samples were collected from nursing staff’s hands and environmental object surfaces. Meropenem was used to screen for CRO strains，and all CRO strains were analyzed for homology. Results A total of 1，170 samples，including 334 hands and 836 surfaces，were collected. A total of 209 CRO strains were detected，with a CRO carriage rate of 17.9%. The burn ICU had the highest carriage rate，accounting for 44.0%. Among them，carbapenem-resistant Acinetobacter baumannii complex，carbapenem-resistant Klebsiella pneumoniae，carbapenem-resistant Enterobacter cloacae，and carbapenem-resistant Pseudomonas aeruginosa accounted for 67.9%，14.8%，11.0%，and 6.2%，respectively. Homology analysis showed clonal transmission of the strains detected in the ICUs，including “hand-to-surface” transmission in three intensive care units，but no interdepartmental or hospital-based transmission was found. Conclusion Different specialized ICUs have carbapenem-resistant Gram-negative bacteria，mainly Acinetobacter baumannii，and clonal transmission of CRO strains within the same ICU unit is more common，including “environment-object-surface” and “hand-object-surface” transmission. This suggests that nursing managers should strengthen the standardized implementation of cluster management of multidrug-resistant bacteria.

Key words: Intensive Care Unit, Carbapenem Resistance, Gram-Negative Organisms, Hospital Infection, Nursing Administration

金丁萍, 王雪瑾, 胡燕燕, 王朦朦, 吴飞宇, 杨晓煊, 陆群. 不同专科ICU碳青霉烯耐药革兰阴性菌分布特征的调查研究[J]. 中华急危重症护理杂志, 2025, 6(5): 530-535.

JIN Dingping, WANG Xuejin, HU Yanyan, WANG Mengmeng, WU Feiyu, YANG Xiaoxuan, LU Qun. Survey on distribution characteristics of carbapenem-resistant organism in intensive care units of different specialties[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 530-535.

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