天津市299名医护人员手部带菌及其耐药分析

目的 了解天津市医护人员手部带菌及其耐药情况.方法 在医护人员消毒洗手前,以灭菌棉拭子涂抹双侧全手掌采样,增菌培养并对分离到的病原菌或条件致病菌做药物敏感性试验.结果 在299份手拭子样本中共有50份带菌,带菌率为16.72%,分离到病原菌或条件致病菌菌株64株,以鲍氏不动杆菌、金黄色葡萄球菌和鲁氏不动杆菌为主要菌种,其中对≥3种抗菌药物耐药的有26株,占全部菌株的40.63%,检出耐甲氧西林葡萄球菌4株.结论 医疗机构医护人员手部带有病原菌与条件致病菌,部分细菌耐药较严重,应引起重视,加强手卫生宣传与管理.     

医护人员鼻腔带菌及对抗菌药物耐药趋势分析

目的 了解天津市医护人员鼻腔自然带菌及耐药的变化趋势.方法 于2008年以灭菌棉拭子对全市150名医护人员双侧鼻腔涂抹采样,对分离出的致病菌或条件致病菌进行药敏试验.结果 150份鼻腔拭子样本中共有126份带菌,带菌率为84.00%,分离出病原菌或条件致病菌149株,以葡萄球菌属为主要菌种,对磺胺甲噁唑/甲氧苄啶的耐药率从2007年的36.36%上升至61.54%,跃居第1位,对甲氧西林的耐药率为37.50%,跃居第2位.结论 医疗机构医护人员鼻腔带菌检出率大幅提高,从2007年革兰阴性菌与革兰阳性菌菌株数量相当,转变为以革兰阳性菌为主,而且对甲氧西林耐药大幅提升,因此应引起重视,加强卫生宣传与管理.     

重症监护病房医务人员鼻腔带菌及其耐药性

目的探讨重症监护病房（ICU）医务人员鼻腔带菌及其耐药情况,为制订医院感染防控措施提供依据。方法采用棉拭子采样法,对某院2014年4月-2015年3月ICU医务人员鼻腔黏膜进行采样,检测其携带病原菌及其耐药情况。结果共采集450份鼻腔标本,分离病原菌137株,检出率为30.44%。不同性别、年龄、工作岗位、工龄、文化程度的医务人员鼻腔带菌检出率比较,差异均无统计学意义（P＞0.05）;医务人员不同季节鼻腔带菌检出率比较,差异具有统计学意义（P＜0.05）。其中革兰阴性菌82株（占59.85%）,以肺炎克雷伯菌（21.16%）、产气肠杆菌（18.98%）为主;革兰阳性菌55株（占40.15%）,以金黄色葡萄球菌（18.98%）、表皮葡萄球菌（15.33%）为主。检出38株（27.74%）多重耐药菌。耐甲氧西林金黄色葡萄球菌占7.69%（2/26）,耐亚胺培南肺炎克雷伯菌占3.45%（1/29）,耐亚胺培南产气肠杆菌占3.85%（1/26）。结论ICU医务人员鼻腔病原菌携带率较高,多重耐药菌检出率高。     

军医大学本科生鼻腔定植金黄色葡萄球菌和其他可培养菌群的筛查

目的了解鼻腔金黄色葡萄球菌(SA)和其他可培养共生菌的定植情况,为鼻腔定植条件致病菌特别是SA的感染预防及其医院感染控制措施的制定提供参考依据。方法采集在某院临床医学课程学习的健康军医大学本科生鼻前庭标本,以微生物自动化系统接种于各类细菌培养基进行细菌培养和菌落观察,对分离菌株采用质谱鉴定,对SA进行抗菌药物敏感性试验。结果共采集鼻前庭标本161份,检出鼻腔定植菌549株,其中革兰阳性菌493株,革兰阴性菌56株,居前三位的细菌为拥挤棒状杆菌(151株)、表皮葡萄球菌(150株)、假白喉棒状杆菌(54株)。共有72种不同的带菌模式,以同时检出金黄色葡萄球菌、表皮葡萄球菌和拥挤棒状杆菌带菌模式的学员最多,达21名(13.04%)。鼻腔SA定植率为25.46%(41/161),耐甲氧西林金黄色葡萄球菌(MRSA)定植率为4.35%(7/161),SA菌株对青霉素、红霉素和克林霉素耐药率为39.02%～78.05%。结论军医大学本科生鼻腔定植菌群以正常菌群为主,需注意定植的SA和其他条件致病菌导致自身感染和引发医院感染的可能性。     

医务人员鼻前庭机会致病菌携带的调查

目的了解重症监护病房（ICU）医务人员鼻前庭带菌情况,以加强ICU医务人员医院感染的预防与控制。方法采用常规方法对ICU工作的93名医务人员和对照组的98名医务人员的鼻前庭拭子进行培养和菌种鉴定。结果从191名医务人员的鼻拭子中分离到214株机会致病菌,其中金黄色葡萄球菌8株,携带率4.19%,均为甲氧西林敏感金黄色葡萄球菌（MSSA）,凝固酶阴性葡萄球菌131株,携带率93.71%,主要是表皮葡萄球菌和溶血葡萄球菌,其中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占50.3%,革兰阴性杆菌27株,携带率14.14%,主要是肺炎克雷伯菌和阴沟肠杆菌,未发现产超广谱β-内酰胺酶（ESBLs）细菌;ICU医务人员鼻前庭金黄色葡萄球菌携带率（6.5%）、MRCNS的携带率（60.2%）、革兰阴性杆菌的携带率（26.9%）均明显高于普通科室（P〈0.05）。结论医院内医务人员间鼻前庭机会致病菌携带率较高,不同科室医务人员之间的机会致病菌的携带存在明显差异,应加强医院医务人员自身感染的预防与控制,特别是长期在ICU工作的医务人员。     

2007—2009年天津市医护人员鼻腔携带表皮葡萄球菌耐药性监测结果分析

目的了解2007—2009年天津医护人员鼻腔分离的表皮葡萄球菌耐药情况及其耐药趋势。方法对连续3年采集的534名医护人员鼻腔拭子分离培养获得的表皮葡萄菌株进行常用抗生素的药物敏感性试验,分析药敏结果。结果 534份鼻腔拭子中检出表皮葡萄球菌172株,平均检出率为32.21%。药敏试验显示,对头孢唑啉、头孢哌酮、利福平、多西环素、阿米卡星保持较低的耐药率（〈10%）,而对复方新诺明、甲氧西林耐药率较高（〉50%）,发现1株对万古霉素耐药的菌株。结论所监测的医护人员表皮葡萄球菌分离率逐年增加,多重耐药情况严重。     

B超探头微生物污染细菌菌型分布及药物敏感分析

目的为了解B超探头微生物污染细菌的菌型分布及药物敏感情况,避免通过B超探头传播的院内交叉感染。方法对8台B超19个未消毒的体外探头共114份监测标本进行菌型鉴定、药物敏感试验,对不同专科使用的探头进行比较。结果采集到监测标本114份,标本带菌阳性率为74.56%(85/114),培养到优势菌85株;致病菌金葡菌10株,G 球菌/G-杆菌=1.83,G 球菌中葡萄球菌属占多数(53.36%);同时发现常见院感菌、条件致病菌多株,其中不乏多耐药的醋酸钙不动杆菌、嗜麦芽窄食单胞菌、产气肠杆菌等,并且培养到MRSA3株、MRSE2株。不同专科使用的探头,带菌阳性率差异有统计学意义,功能科的阳性率显著高于妇产科、体检科,妇产科阳性率高于体检科。结论提高医务人员相关消毒隔离意识,掌握B超探头的优势菌型分布及细菌耐药情况,为制定医院内交叉感染控制对策提供依据。     

金黄色葡萄球菌医院感染与外环境关系的研究

目的　分析比较金黄色葡萄球菌医院感染与外环境金黄色葡萄球菌的相关性 ,以了解医院感染病原菌来源。方法　采用分层随机抽样方法抽取深圳市宝安区 15家医院中的 3家医院 (A医院为区级 ,B、C医院为镇级 ) ,连续 5个月收集 3家医院金黄色葡萄球菌的医院感染株、社区感染株、环境株 ,比较 3种来源菌株的耐药谱以及随机引物扩增多态性基因分型 (RAPD)型别之间的差异 ,判断三者之间的相关性。结果　收集金黄色葡萄球菌医院感染株 6株 ,社区感染株 3株 ;在 1190份环境样中共分离到金黄色葡萄球菌 9株 ,环境分离率为 0 76 %。耐药性分析显示环境株、医院感染株对苯唑西林、头孢噻吩、红霉素、复方新诺明的耐药率差异有显著性 (P <0 0 5或P <0 0 1)。RAPD分型分析显示A医院的 4株医院感染株、2株环境株以及 2株社区感染株均属于A型 ;B医院的 1株医院感染株和 1株社区感染株同属C型 ,表明医院感染株与社区感染株、环境株之间存在明显相关性。结论　金黄色葡萄球菌医院感染可能以外源性途径为主。     

医院金黄色葡萄球菌耐药及质粒同源性分析

目的 了解医院环境金黄色葡萄球菌耐药性及质粒同源性,为制定预防外源性医院感染措施提供依据.方法 抽取2所省级医院5个科室进行消毒前随机采样,进行细菌培养分离鉴定,并对金黄色葡萄球菌进行药敏实验,质粒消除、质粒图谱及限制性内切酶图谱分析.结果 196份样本中,分离到金黄色葡萄球菌15株.占7.7%;其中空气检出率最高,为19.1%.金黄色葡萄球菌的青霉素耐药率为60.0%,3种或以上耐药46.7%;有12株(80.0%)检出质粒,11株含质粒的耐药金葡菌进行质粒消除后,有9株耐药性变化,2株未变化.耐药质粒分子量1.06～39.93kb.3株含有共同耐药谱的乙医院烧伤科金葡菌有相似质粒.不同医院也有相似质粒谱.用EcoRI酶切4株金葡菌质粒后,质粒片段增多,分子量变化,含有5种相同大小的质粒.结论 金葡菌的高危传播途径是空气且耐药性高,不同医院和不同科室的金葡菌有同源耐药质粒.     

不同采样工具对医务人员鼻腔携带菌主动筛查结果分析

目的 利用两种采样工具对医务人员鼻腔携带菌进行主动筛查,比较结果差异,探讨神经外科医务人员鼻腔多重耐药菌（MDRO）定植情况,为MDRO的防控提供依据。方法 选取2019年7月某院神经外科110名在岗医务人员为研究对象,主动筛查其鼻腔带菌情况。医务人员左侧鼻孔采用0.85%生理盐水采样管（简称海绵拭子）,右侧鼻孔采用一次性鼻腔拭子（简称棉拭子）,比较两种工具的采样结果。对检出的MDRO进行耐药性分析、去定植,另外对病房采取集束化干预措施,并比较干预前后的效果。结果 110名医务人员,包括医生31名,护士66名,护工7名,进修及规培生6名。共检出细菌46株,其中10株MDRO,耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯类鲍曼不动杆菌检出率分别为8.18%及0.91%,未检出耐碳青霉烯类肠杆菌、耐碳青霉烯类铜绿假单胞菌、耐万古霉素肠球菌。两种采样方式收集的标本培养24、48及72 h,两组菌落检出结果及半定量结果比较,差异均无统计学意义（均P>0.05）;两种采样方法的采样时间、一次性采集成功率、耗材损耗率、医务人员满意度各指标比较,差异均有统计学意义（均P<0.05）。棉拭子优于海绵拭子,且成本较低。检出的9株MRSA对红霉素、克林霉素耐药率较高,2株分离自护士的MRSA药敏谱表型完全一致。采取防控措施后,8名医护人员MRSA阳性者均转阴,且病房MDRO及其中的MRSA、CRAB的感染率及检出率较干预前均有所下降（P<0.05）。结论 神经外科医务人员鼻腔MRSA定植率较高,生理盐水采样管及一次性鼻腔拭子细菌检出结果几乎一致,从各种指标尤其是成本效益方面综合考量,棉拭子优于海绵拭子。建议对重点科室医务人员做鼻腔定植菌的监测,及时去定植,加强以接触隔离为核心的综合防控措施,以确保有效降低临床MDRO的发生率及医务人员的定植率。     

Nasal carriage and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital personnel in Abha, Saudi Arabia

The prevalence of nasal carriage of Staphylococcus aureus, antibiograms and prevalence of methicillin-resistant S. aureus (MRSA) were studied in 1999 among healthy hospital and non-hospital personnel in Abha, Saudi Arabia. S. aureus was isolated from 26.1% of 299 adults in the community and 25.4% of 279 hospital personnel. No isolate was resistant to vancomycin. Antibiotic resistance rates, for all other antibiotics tested except cephalothin, were significantly higher for strains from hospital personnel (P values < 0.001-0.04) compared to non-hospital adults. The antibiograms were also compared with those of 140 clinical isolates. The rates of resistance of the inpatient strains to all the antibiotics tested were significantly higher than those of hospital nasal carrier strains (P < 0.001-0.05). MRSA was isolated, respectively, from 5.1% and 18.3% of non-hospital and hospital carriers; MRSA carriage rates were 1.3% and 4.7%, respectively, for non-hospital and hospital carriers, and 61% of S. aureus isolates from infected patients were MRSA. Only 8% of non-hospital but 44% of hospital carrier strains were multiply resistant (P < 0.001). Multiple resistance among inpatient strains (89%) was significantly higher than that among hospital nasal strains (44%) (P < 0.001). Such rates of multiple resistance and endemic MRSA prevalence among healthy carriers (11%) at a much higher rate than those reported in the literature should raise concern in a region with unrestricted availability of antibiotics.     

社区糖尿病人群携带金黄色葡萄球菌的 分型与耐药谱关系研究

摘要:目的　了解社区糖尿病人群携带金黄色葡萄球菌的分型情况并分析其耐药谱。方法　随机抽取佛山市里水镇11个社区糖尿病人438名并收集其鼻拭子样本,根据传统实验室方法分离鉴定金黄色葡萄球菌,采用头孢西丁纸片扩散法和mecA基因扩增法进行耐甲氧西林金黄色葡萄球菌（Methicillin-Resistant Staphylococcus Aureus,MRSA）的鉴定,利用多重聚合酶链式反应（Polymerase Chain Reaction,PCR）的方法对MRSA菌株进行葡萄球菌染色体盒（Staphyloccoccal Cassette Chromosome mec,SCCmec）的分子分型,应用K-B纸片扩散法分析金黄色葡萄球菌的耐药谱。结果　438份样本中分离出43株金黄色葡萄球菌,检出率为9.82%,其中22株（5.02%）为MRSA。22株MRSA中,医院获得性耐甲氧西林金黄色葡萄球菌（Hospital-Acquired MRSA,HA-MRSA）7株,社区获得性耐甲氧西林金黄色葡萄球菌（Community-Acquired MRSA,CA-MRSA）10株,SCCmec未分型5株。金黄色葡萄球菌除对替考拉宁无耐药外,对其他抗生素均有不同程度的耐药,MRSA的耐药率普遍高于甲氧西林敏感金黄色葡萄球菌（Methicillin Sensitive Staphylococcus Aureus,MSSA）的耐药率,两者对红霉素和克林霉素耐药率差异有统计学意义,36.36%（8/22）的MRSA具有多重耐药性,MSSA中未发现多重耐药菌株。结论　该地区糖尿病人群携带的金黄色葡萄球菌中MRSA比例高,所携带的MRSA中以CA-MRSA为主,MRSA对抗生素的多重耐药问题值得重视。     

Staphylococcus aureus nasal carriage in a student community: prevalence, clonal relationships, and risk factors.

OBJECTIVE: To evaluate the prevalence and risk factors of nasal Staphylococcus aureus (SA) in the community. DESIGN: Cross-sectional study. SETTING: Wake Forest University, Winston-Salem, North Carolina. PARTICIPANTS: Four hundred fifty students were screened for nasal SA carriage during the fall of 2000, 2001, and 2002. METHODS: Students were screened by nose swabs. A self-administered questionnaire collected information on demographics and medical history. Antibiotic testing and PFGE were performed on isolates. Risk factors were determined by logistic regression analysis. RESULTS: Of 450 volunteers, 131 (29%) were SA carriers. Antibiotic resistance was high for azithromycin (26%) and low for ciprofloxacin (1%), tetracycline (5%), mupirocin (1%), and methicillin (2%). PFGE patterns were not associated with carriage. Age, male gender, white race, medical student, allergen injection therapy, chronic sinusitis, rheumatoid arthritis, hospitalization for 6 months or less, and use of antibiotics were associated with carrier status by univariate analysis. Stepwise multivariate logistic regression led to a best fitting model with older age (OR, 1.04; CI95, 1.005-1.079), male gender (OR, 1.50; CI95, 0.982-2.296), and chronic sinusitis (OR, 2.71; CI95, 0.897-8.195) as risk factors. Antibiotic use (< 4 weeks) (OR, 0.41; CI95, 0.152-1.095) and allergen injection therapy (OR, 0.41; CI95, 0.133-1.238) were protective. Analyses of carriers revealed candidate factors for persistent carriage to be nasal SA colonization rate and male gender. Factors for azithromycin resistance were non-medical students and antibiotic use in the past 6 months. CONCLUSION: Older male volunteers suffering from chronic sinusitis and not taking antibiotics were at higher risk for carrying SA.     

医院感染病原菌的耐药性监测分析

目的 分析医院感染病原菌耐药情况,为临床合理使用抗菌药物、减少耐药性提供参考.方法 对2010年医院感染病例中分离出的病原菌的耐药性进行统计分析.结果 革兰阴性菌占75.28％,革兰阳性菌占18.80％,真菌占5.92％;病原菌检出首位的是铜绿假单胞菌756株,占38.61％,对碳青霉烯类药物亚胺培南耐药率为65.34％,检出第2位的是鲍氏不动杆菌317株,占16.19％,对氨基糖苷类抗菌药物阿米卡星较为敏感,其耐药率为70.98％,检出第3位的是大肠埃希菌114株,占5.82％,产ESBLs对青霉素类药物、头孢菌素类药物、喹诺酮类药物耐药率偏高;金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌除对万古霉素敏感外,对其他抗菌药物均显示高耐药性.结论 医院感染病原菌耐药性明显,加强耐药性监测,合理使用抗菌药物,提高医务人员手卫生的依从性,是减缓耐药菌传播,控制医院感染的有力措施.     

Nasal carrier rates and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital populations,Addis Ababa

Surgical staff of five different hospitals and university biology students were screened for nasal carriage of Staphylococcus aureus: 32·4% of the surgical staff and 21·6% of the students were carriers. The rate for the hospital staff was significantly higher (χ² = 9·2, P<0·01). The carrier rates among the surgical staff varied between 59·1% for surgeons and 22·7% for other surgical staff.195 S. aureus strains were isolated: 109 from surgical staff and 86 from students. All were tested for their resistance to antibiotics. Resistance to penicillin was 86·2% and 74·4%, respectively, for hospital and non-hospital isolates. Resistance to erythromycin, gentamicin, kanamycin or co-trimoxazole was not detected among the non-hospital isolates. All isolates were sensitive to vancomycin, cephalothin and clindamycin. Over 96% and 88% of hospital and non-hospital isolates, respectively, were resistant to at least one antibiotic. About 45% of the hospital isolates and 2·3% of the non-hospital isolates showed multiple resistance.The rate of multiple resistance among the hospital staff isolates was considered high and indicative of still higher rates among clinical isolates. Further studies are suggested in order to take appropriate measures against bacterial resistance to antibiotics.     

Nasal carriage of methicillin-resistant Staphylococcus aureus among hospital staff and outpatients.

This study sought to determine the rate of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage among hospital staff and outpatients. Nasal swabs were obtained from 500 outpatients and 500 hospital staff. Hospital staff were 2.3-fold more likely to carry MRSA than were outpatients (6% vs 2.6%, P = .013).     

广州市HIV感染者鼻腔携带MRSE与MSSE菌株的耐药谱及遗传特征比较

目的 比较广州市HIV感染者鼻腔携带耐甲氧西林表皮葡萄球菌(methicillin - resistant Staphylococcus epidermidis, MRSE)与甲氧西林敏感表皮葡萄球菌(methicillin sensitive Staphylococcus epidermidis, MSSE)的耐药谱及遗传特征。方法 于2017年6 - 8月,对广州市某医院艾滋病门诊1 001名HIV感染者鼻腔分离的表皮葡萄球菌进行药物敏感性试验及毒素基因、耐消毒基因、耐药基因检测。结果 分离鉴定出422株表皮葡萄球菌,包括309(73.22%)株MRSE,113(26.78%)株MSSE。MRSE菌株对青霉素、头孢西丁、红霉素、四环素、莫西沙星、复方新诺明这6种抗生素的耐药率高于MSSE,差异均有统计学意义。MRSE菌株的多重耐药率达77.99%,高于MSSE(36.28%)。MRSE菌株毒素基因pvl的检出率为9.06%,耐消毒基因qacA/B、smr的检出率分别为53.72%、11.33%,耐药基因aac(6’) - aph(2’)的检出率(63.75%)最高。结论 广州市HIV感染者鼻腔MRSE的检出率和多重耐药率高,MRSE耐药情况较MSSE严重;耐消毒基因qacA/B和耐药基因aac(6’) - aph(2’)的检出率高。     

Nasal carriers of coagulase-positive staphylococci in a Nigerian hospital community

Nasal swabs taken from 324 subjects in a Nigerian hospital were examined for the presence of coagulase-positive staphylococci. The subjects used in this study included the patients, staff and “auxiliaries” aged from one day to 70 years. The results obtained show that approximately 50% of all the subjects were nasal carriers of Staphylococcus aureus and that age, occupation and length of the subjects' stay in hospital had a significant effect on this figure. It was also found that there is no significant difference between the prevalence of nasal carriage of S. aureus amongst the hospital staff and the patients.