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中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (01) : 3 -8. doi: 10.3877/cma.j.issn.2096-1537.2019.01.002

所属专题: 文献

临床研究

重症医学科医护人员鼻前庭致病菌定植及危险因素
许娜娜1, 周敏2, 孙恩华3, 李伟3, 秦伟栋2, 张帆2, 翟茜2, 丁士芳2, 李琛2, 陈晓梅2, 吴大玮2, 王昊2,()   
  1. 1. 250000 济南,山东大学齐鲁医学院
    2. 250012 济南,山东大学齐鲁医院重症医学科
    3. 250012 济南,山东大学齐鲁医院检验科
  • 收稿日期:2018-02-25 出版日期:2019-02-28
  • 通信作者: 王昊
  • 基金资助:
    国家自然科学基金(81501786); 山东省自然科学基金(ZR2017PH050); 山东省医药卫生科技发展计划项目(2015WS0291)

Nasal pathogenic bacteria colonization and related risk factors among medical staff of intensive care unit

Nana Xyu1, Min Zhou2, Enhua Sun3, Wei Li3, Weidong Qin2, Fan Zhang2, Qian Zhai2, Shifang Ding2, Chen Li2, Xiaomei Chen2, Dawei Wu2, Hao Wang2,()   

  1. 1. Cheeloo College of Medicine, Shandong University, Jinan 250000, China
    2. Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250000, China
    3. Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan 250000, China
  • Received:2018-02-25 Published:2019-02-28
  • Corresponding author: Hao Wang
  • About author:
    Corresponding author: Wang Hao, Email:
引用本文:

许娜娜, 周敏, 孙恩华, 李伟, 秦伟栋, 张帆, 翟茜, 丁士芳, 李琛, 陈晓梅, 吴大玮, 王昊. 重症医学科医护人员鼻前庭致病菌定植及危险因素[J/OL]. 中华重症医学电子杂志, 2019, 05(01): 3-8.

Nana Xyu, Min Zhou, Enhua Sun, Wei Li, Weidong Qin, Fan Zhang, Qian Zhai, Shifang Ding, Chen Li, Xiaomei Chen, Dawei Wu, Hao Wang. Nasal pathogenic bacteria colonization and related risk factors among medical staff of intensive care unit[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(01): 3-8.

目的

了解重症医学科(ICU)医护人员鼻前庭致病菌定植情况及危险因素。

方法

2017年2至5月,纳入山东大学齐鲁医院ICU中工作年限≥1年、非感染状态的医护人员,行鼻前庭拭子采样、培养,采集一般资料并抽血送检血常规等化验,使用多因素Logistic回归分析筛选鼻前庭致病菌定植的独立危险因素。

结果

纳入医护人员81例,有效样本50例,致病菌定植阳性者25例(50.0%)。共分离出致病菌31株,其中金黄色葡萄球菌14株(45.2%;耐甲氧西林2株)、产气肠杆菌5株(16.1%)、肺炎克雷伯杆菌4株(12.9%)、枸橼酸杆菌4株(12.9%)、产酸克雷伯杆菌2株(6.5%)、阴沟肠杆菌1株(3.2%)、奇异变形杆菌1株(3.2%)。与无致病菌定植者相比,鼻前庭定植者ICU工作年限偏短[(5.1±3.1)年 vs (8.4±5.5)年]、鼻咽部不适史更常见(68.0% vs 28.0%)、手卫生依从性差(80.0% vs 28.0%)且每日床旁接触患者时间更长(>4 h)(88.0% vs 56.0%),差异具有统计学意义(t=2.654,P=0.012;χ2=8.013,P=0.005;χ2=13.607,P=0.001;χ2=6.349,P=0.012);除上述危险因素外,金黄色葡萄球菌定植者的血中性粒细胞百分比率更高[(59.5±5.8)% vs (52.7±8.8)%,t=﹣2.588,P=0.014]、淋巴细胞比率更低[(32.9±5.3)% vs (39.2±7.5)%,t=2.795,P=0.008]。多因素Logistic回归分析结果显示,鼻咽部不适史(OR=14.223,95%CI:1.152~75.575,P=0.038)和手卫生依从性(OR=13.899,95%CI:3.130~61.725,P=0.001)是鼻前庭致病菌定植的独立危险因素。

结论

半数ICU医护人员存在鼻前庭致病菌定植,值得警惕。提高手卫生依从性并早期处理鼻咽部不适症状可能对降低致病菌定植率有益。

Objective

To investigate the status and risk factors of nasal pathogenic bacteria colonization among medical staff of intensive care unit (ICU).

Methods

From February to May 2017, we recruitedthe non-infected ICU medical staff with ≥1 year ICU experience in Qilu Hospital of Shandong University. We collected the general data, blood samples and nasal vestibular swab samples for bacterial culture. Multivariate Logistic regression analysis was used to generate the independent risk factors for the nasal pathogenic bacteria colonization.

Results

81 doctors and nurses were enrolled and 50 effective cases were included, 25 cases (50.0%) were identified with nasal pathogenic bacteria colonization. A total of 31 strains were isolated, of which 14 Staphylococcus aureus (45.2%; 2 methicillin-resistant isolates), 5 (16.1%) Enterobacteraerogenes, 4 (12.9%) Klebsiella pneumonia, 4 (12.9%) Citrobacter strains, 2 (6.5%)Klebsiellaoxytoca, 1(3.2%) Enterobacter cloacae, 1 (3.2%) Proteus mirabilis. Compared with those without pathogen colonization, the cases with pathogen colonization had significant shorter working period [(5.1±3.1) years vs (8.4±5.5) years], more frequent nasopharyngeal discomfort (68.0% vs 28.0%), and worse hand hygiene compliance (80.0% vs 28.0%), longer daily bedside contacting time with patients (>4 h) (68.0% vs 28.0%) (all P<0.05). In addition to the above risk factors, the cases colonized with Staphylococcus aureus had significant higher blood neutrophils percentage [(59.5±5.8)% vs (52.7±8.8)%, t=-2.588, P=0.014] and lower lymphocyte percentage [(32.9±5.3)% vs (39.2±7.5)%, t=2.795, P=0.008] (all P<0.05). Multivariate analysis revealed that nasopharyngeal discomfort history (OR=14.223, 95% CI: 1.152-75.575, P=0.038) and bad hand hygiene compliance (OR=13.899, 95% CI: 3.130-61.725, P=0.001) were independent risk factors for nasal pathogenic bacteria colonization (P<0.05).

Conclusions

It should be noticed thatnear half ICU medical staff had nasal pathogenic bacteria colonization. Improving hand hygiene compliance and early handling of nasopharyngeal symptoms may be beneficial for reducing the nasal colonization rate of pathogens.

表1 ICU医护人员一般资料及单因素分析情况[例(%)]
组别 例数 年龄(岁, ± s 男性 职务 职称 学历
医生 护士 初级 中级及以上 专科 本科 研究生及以上
致病菌定植组 25 29.5±5.1 8(32.0) 3(12.0) 22(88.0) 21(84.0) 4(16.0) 2(8.0) 19(76.0) 4(16.0)
无致病菌定植组 25 31.8±5.8 8(32.0) 5(20.0) 20(80.0) 17(68.0) 8(32.0) 0(0.0) 20(80.0) 5(20.0)
统计值 ? t=1.485 χ2=0.000 χ2=0.149* χ2=1.754 χ2=1.811*
P ? 0.144 1.000 0.700 0.185 0.559
组别 例数 ICU工作年限(年, ± s BMI(kg/m2 ± s 慢性鼻炎史 吸烟史 每日清洗鼻腔 鼻咽部不适史 手卫生依从性差 口罩佩戴层数
一层 >一层
致病菌定植组 25 5.1±3.1 21.9±2.8 6(24.0) 1(4.0) 0(0.0) 17(68.0) 20(80.0) 15(60.0) 10(40.0)
无致病菌定植组 25 8.4±5.5 22.7±2.8 1(4.0) 0(0.0) 4(16.0) 7(28.0) 7(28.0) 18(72.0) 7(28.0)
统计值 ? t=2.654 t=0.976 χ2=2.658* χ2=0.000* χ2=2.446* χ2=8.013 χ2=13.607 χ2=0.802
P ? 0.012 0.334 0.103 1.000 0.118 0.005 0.001 0.370
组别 例数 每天接触患者时间>4 h 白细胞计数(×109/L,±s 中性粒细胞比率(%,±s 淋巴细胞比率(%,±s 血红蛋白(g/L,±s 总胆固醇(mmol/L,±s 三酰甘油(mmol/L,±s 血糖(mmol/L,±s 血小板计数(×109/L,±s
致病菌定植组 25 22(88.0) 6.0±1.4 57.1±7.8 35.2±7.6 138.2±22.4 4.1±0.8 1.0±0.6 4.8±0.4 246.6±41.2
无致病菌定植组 25 14(56.0) 5.9±1.1 52.7±8.8 39.2±7.5 139.8±17.6 4.3±0.8 1.2±0.5 4.8±0.4 253.3±49.9
统计值 ? χ2=6.349 t=﹣0.344 t=﹣1.873 t=1.904 t=0.274 t=0.878 t=1.197 t=0.112 t=0.516
P ? 0.012 0.733 0.067 0.063 0.785 0.384 0.237 0.911 0.608
表2 ICU医护人员鼻前庭致病菌检出情况及药敏结果[例(%),31株]
表3 ICU医护人员鼻前庭致病菌定植危险因素的多因素Logistic回归分析
表4 ICU医护人员鼻前庭金黄色葡萄球菌定植危险因素的单因素分析[例(%)]
组别 例数 年龄(岁) 男性 职务 职称 学历
医生 护士 初级 中级及以上 专科 本科 研究生及以上
金黄色葡萄球菌定植组 14 28.9±3.5 5(35.7) 1(7.1) 13(92.9) 12(85.7) 2(14.3) 1(7.1) 11(78.6) 2(14.3)
无金黄色葡萄球菌定植组 25 31.8±5.8 8(32.0) 5(20.0) 20(80.0) 17(68.0) 8(32.0) 0(0.0) 20(80.0) 5(20.0)
统计值 ? t=1.697 χ2=0.014 χ2=0.366* χ2=0.694* χ2=1.951*
P ? 0.098 0.906 0.545 0.405 0.377
组别 例数 ICU工作年限(年, ± s BMI(kg/m2 ± s 慢性鼻炎史 吸烟史 每日清洗鼻腔 鼻咽部不适史 手卫生依从差 口罩佩戴层数
一层 >一层
金黄色葡萄球菌定植组 14 5.0±3.5 22.6±3.2 5(35.7) 1(7.1) 0(0.0) 11(78.6) 11(78.6) 9(64.3) 5(35.7)
无金黄色葡萄球菌定植组 25 8.4±5.5 22.7±2.8 1(4.0) 0(0.0) 4(16.0) 7(28.0) 7(28.0) 18(72.0) 7(28.0)
统计值 ? t=2.096 t=0.033 χ2=4.712* χ2=0.089* χ2=1.060* χ2=9.235 χ2=9.235 χ2=0.019
P ? 0.043 0.974 0.030 0.766 0.303 0.002 0.002 0.889
组别 例数 每天接触患者时间>4 h 白细胞计数(×109/L,±s 中性粒细胞比率(%,±s 淋巴细胞比率(%,±s 血红蛋白(g/L,±s 总胆固醇(mmol/L,±s 三酰甘油(mmol/L,±s 血糖(mmol/L,±s 血小板计数(×109/L,±s
金黄色葡萄球菌定植组 14 14(100.0) 6.3±1.6 59.5±5.8 32.9±5.3 137.9±27.8 4.1±0.9 1.3±0.7 4.8±0.3 256.6±40.4
无金黄色葡萄球菌定植组 25 16(64.0) 5.9±1.1 52.7±8.8 39.2±7.5 139.8±17.6 4.3±0.8 1.2±0.5 4.8±0.4 253.3±49.9
统计值 ? χ2=4.124 t=﹣0.753 t=﹣2.588 t=2.795 t=0.228 t=0.816 t=0.232 t=0.270 t=﹣0.211
P ? 0.042 0.460 0.014 0.008 0.822 0.420 0.818 0.788 0.834
1
Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection [J]. New Engl J Med, 2013, 368(24): 2255-2265.
2
Septimus EJ, Schweizer ML. Decolonization in prevention of health care-associated infections [J]. Clin Microbiol Rev, 2016, 29(2): 201-222.
3
Sollid JUE, Furberg AS, Hanssen AM, et al. Staphylococcus aureus: determinants of human carriage [J]. Infect Genet Evol, 2014, 21(1): 531-541.
4
Khairalla AS, Wasfi R, Ashour HM. Carriage frequency, phenotypic, and genotypic characteristics of methicillin-resistant Staphylococcus aureus isolated from dental health-care personnel, patients, and environment [J]. Sci Rep-UK, 2017, 7(1): 7390.
5
于佳佳, Nittita Prasopa-Plaizier, 叶旭春. 世界卫生组织手卫生五个时刻的解读及启示 [J]. 解放军护理杂志, 2012, 29(22): 75-76.
6
Clinical and Laboratory Standards Institute. M100S. Performance standards for antimicrobial susceptibility testing: twenty-sixth edition [S]. Wayne, PA: CLSI, 2016.
7
Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? [J]. Lancet Infect Dis, 2008, 8(5): 289-301.
8
南玲, 刘丁, 李茂圆, 等. 重症监护病房医务人员鼻前庭细菌定植情况及耐药性调查 [J]. 中国感染控制杂志, 2016, 15(8): 608-611.
9
王茹, 陈倩, 祝丙华, 等. 医院重点科室医护人员鼻前庭病原菌携带情况调查 [J]. 中国消毒学杂志, 2015, 32(4): 351-353.
10
Stannard W, O’Callaghan C. Ciliary function and the role of cilia in clearance [J]. J Aerosol Med, 2006, 19(1): 110-115.
11
Faibis F, Laporte C, Fiacre A, et al. An outbreak of methicillin-resistant Staphylococcus aureus surgical-site infections initiated by a healthcare worker with chronic sinusitis [J]. Infect Cont Hosp Ep, 2005, 26(2): 213-215.
12
Chen B, Dai X, Bo H, et al. Differences in Staphylococcus aureus nasal carriage and molecular characteristics among community residents and healthcare workers at Sun Yat-Sen University, Guangzhou, Southern China [J]. BMC Infect Dis, 2015, 15(1): 303.
13
Castro A, Komora N, Ferreira V, et al. Prevalence of Staphylococcus aureus from nares and hands on health care professionals in a Portuguese Hospital [J]. J Appl Microbiol, 2016, 121(3): 831-839.
14
秦小平, 于磊, 魏建民, 等. 18所医疗机构医务人员手卫生现状调查 [J]. 中华医院感染学杂志, 2017, 27(8): 1905-1908.
15
Dai H, Milkman KL, Hofmann DA, et al. The impact of time at work and time off from work on rule compliance: the case of hand hygiene in health care [J]. J Appl Psychol, 2015, 100(3): 846-862.
16
Price JR, Cole K, Bexley A, et al. Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencing [J]. Lancet Infect Dis, 2017, 17(2): 207-214.
17
Rigby KM, DeLeo FR. Neutrophils in innate host defense against Staphylococcus aureus infections [J]. Semin Immunopathol, 2012, 34(2): 237-259.
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