魏仲梅 倪玉娥 刘惠芬 黄志坚 马璐璐

【摘要】 目的：分析惠州市某三級综合医院诊疗区水源性多重耐药菌定植情况，并探讨其与院内感染的关系。方法：于2019年4月-2020年2月对惠州市某三级综合医院内各重症监护室护士站水龙头水样、病房床旁水龙头水样、水龙头内壁及水池下水口处进行采样和细菌学培养，判断其是否合格，分离医院感染常见水源性多重耐药菌（鲍曼不动杆菌和铜绿假单胞菌）。监测同期住院患者院内感染率，并分析水源性多重耐药菌定植是否为院内感染的影响因素。结果：医护水龙头和床旁水龙头水样合格率分别为85.71%和83.33%。56份水龙头内壁样品中总体铜绿假单胞菌检出率为14.29%，总体鲍曼不动杆菌检出率为10.71%，其中RICU均检出率（50.00%）最高，其次为NICU（22.22%）。56份洗手池下水口处样品中总体铜绿假单胞菌检出率为16.07%，总体鲍曼不动杆菌检出率为10.71%，其中RICU均检出率（50.00%）最高，其次为NSICU（22.22%）。ICU、EICU、RICU、NSICU均有铜绿假单胞菌同期院内感染检出，而ICU、RICU、NSICU均有鲍曼不动杆菌同期院内感染检出。单变量COX风险分析结果显示，ICU、EICU、RICU、NSICU水源性铜绿假单胞菌定植与ICU、RICU、NSICU水源性鲍曼不动杆菌定植均为院内感染的相关因素（P<0.05）。进一步院内感染危险因素的logistic回归分析结果显示，ICU、EICU、RICU、NSICU水源性铜绿假单胞菌定植与ICU、RICU、NSICU水源性鲍曼不动杆菌定植均是院内感染的危险因素（P<0.05）。结论：惠州市某三级综合医院诊疗区存在水源性多重耐药菌定植情况且可能影响其院内感染状况，对诊疗区医护用水、水龙头滤网、水池的清洁消毒有助于院内感染的预防。

【关键词】 水源性 多重耐药菌 定植 院内感染

The Relationship Between the Colonization of Water-borne Multidrug-resistant Bacteria and Nosocomial Infection in the Diagnosis and Treatment Area of the Tertiary General Hospital in Huizhou City/WEI Zhongmei， NI Yue， LIU Huifen， HUANG Zhijian， MA Lulu. //Medical Innovation of China， 2021， 18（01）： -137

[Abstract] Objective： To analyze the colonization of water-borne multidrug-resistant bacteria in the diagnosis and treatment area of the tertiary general hospital in Huizhou city， and to explore its relationship with nosocomial infection. Method： From April 2019 to February 2020， the water samples of nurse stations faucets， the water samples of bedside faucets， the inner wall of faucets and the water outlets of water pools in all ICU of a tertiary general hospital of Huizhou City were sampled and cultured for bacteriology to determine whether they were qualified. The common water-borne multidrug-resistant bacteria （Acinetobacter baumannii and Pseudomonas aeruginosa） for hospital infection were isolated. The nosocomial infection rate of hospitalized patients in the same period were monitored， and whether the colonization of water-source multidrug-resistant bacteria was an influential factor for nosocomial infection was analyzed. Result： The qualified rate of water samples from medical and bedside faucets was 85.71% and 83.33%， respectively. The overall detection rate of Pseudomonas aeruginosa and Acinetobacter baumannii in 56 samples of faucet inner wall was 14.29% and 10.71%， among which RICU （50.00%） were the highest， followed by NICU （22.22%）. The overall detection rate of Pseudomonas aeruginosa and Acinetobacter baumannii was 16.07% and 10.71% in the 56 samples of water pools outlets， among which RICU （50.00%） were the highest， followed by NSICU （22.22%）. Pseudomonas aeruginosa nosocomial infection was detected in ICU， EICU， RICU and NSICU， while Acinetobacter baumannii was detected in ICU， RICU and NSICU. Univariate COX risk analysis results showed that the colonization of Pseudomonas aeruginosa in ICU， EICU， RICU， and NSICU and the colonization of Acinetobacter baumannii in ICU， RICU， and NSICU were all related factors for nosocomial infection （P<0.05）. The further logistic regression analysis results of risk factors for nosocomial infection showed that the colonization of Pseudomonas aeruginosa in ICU， EICU， RICU， and NSICU and the colonization of Acinetobacter baumannii in ICU， RICU， and NSICU were risk factors for nosocomial infection （P<0.05）. Conclusion： The colonization of water-borne multidrug-resistant bacteria is observed in the diagnosis and treatment area of a tertiary general hospital in Huizhou city and may affect the nosocomial infection. The cleaning and disinfection of medical water， faucet screen and water pool in the diagnosis and treatment area are helpful to the prevention of nosocomial infection.

[Key words] Water-borne Multidrug-resistant bacteria Colonization Nosocomial infection

First-authors address： The Third Peoples Hospital of Huizhou City， Huizhou 516000， China

doi：10.3969/j.issn.1674-4985.2021.01.033

重症监护病房 （intensive care unit，ICU）的院内感染发病率较高，而其院内感染的发生可加重患者病情甚至引发死亡的发生[1-2]。廖丹等[3]研究认为水龙头是ICU重要污染源，因此应重视水龙头清洁消毒。鲍曼不动杆菌和铜绿假单胞菌是水源性多重耐药菌，与院内感染密切相关[4-5]。……