上海预防医学2025，Vol.37Issue(4)：289-295,7.DOI:10.19428/j.cnki.sjpm.2025.24569
2021-2023年上海市闵行区某医疗机构肺炎克雷伯菌环境污染风险及耐药性分析
Contamination risk and drug resistance analysis of Klebsiella pneumoniae in a medical institution in Minghang District,Shanghai,2021‒2023
摘要
Abstract
[Objective]To investigate the contamination status,transmission risk and drug resistance of Klebsiella pneumoniae(KP)on the object surfaces in the surrounding environment of hospitalized patients infected with carbapenem-resistant Klebsiella pneumoniae(CRKP),so as to provide a scientific guidance for the prevention and control of healthcare-associated infection.[Methods]Samples from the surfaces of objects in the surrounding environment of CRKP infected patients living in the intensive care unit(ICU)and hand specimens from healthcare workers were collected for KP isolation and identification,as well as drug susceptible test in a medical institution located in Minhang District,Shanghai from 2021 to 2023.Additionally,both univariate and multivariate logistic regression analyses were used to identify the influencing factors associated with KP contamination in the hospital environment.[Results]A total of 546 surface samples were collected from the surrounding environment objects of 15 patients infected with CRKP,with a KP detection rate of 6.59%(36/546).The KP detection rate in the ICU of general ward(10.22%)was higher than that in the ICU of emergency department(2.94%)(χ2=12.142,P<0.001).Moreover,the KP detection rate on the surfaces of patient-contacted items(15.66%)was higher than that on shared-use items(6.25%),cleaning items(10.00%),and medical supplies(3.30%)(χ2=17.943,P<0.001).Besides,the detection rate of KP in items sent out of hospital for disinfection(15.38%)was higher than that in those self-disinfected(4.20%)(χ2=19.996,P<0.001).The highest detection rate of KP was observed in high-temperature washing(15.13%,18/119)(χ2=21.219,P<0.001),while the lowest detection rate was observed in antibacterial hand sanitizer with trichlorohydroxydiphenyl ether sanitizing factor(0,0/60)(χ2=21.219,P<0.001).The detection rate of KP in samples taken more than 24 hours after the last disinfection(23.08%)was higher than that in those taken at 4 to 24 hours(12.90%)and less than 4 hours(4.22%)(χ2=23.398,P<0.001).ICU of general ward(OR=4.045,95%CI:2.206‒7.416),patient-contacted items(OR=3.113,95%CI:1.191‒8.141),and self-disinfection(OR=0.241,95%CI:0.144‒0.402)were influencing factors for KP contamination in environmental surface.From 2021 to 2023,the drug resistance rates of hospital environmental KP isolates showed an upward trend(P<0.001)to antibiotics such as ceftazidime and gentamicin.Furthermore,high drug resistance rates of KP(>90%)were observed to ciprofloxacin,levofloxacin,cefotaxime,ceftriaxone,and cefepime.[Conclusion]CRKP can be transmitted outward through the surfaces of objects in the patients'surroundings,and the drug resistance situation is severe.In clinical settings,it is necessary to implement isolation measures for CRKP infection patients,to increase the frequency of disinfection for objects in their surroundings,to strengthen hand hygiene practices,and to use antibiotics appropriately.关键词
耐碳青霉烯类肺炎克雷伯菌/患者周围环境/影响因素/耐药性Key words
carbapenem-resistant Klebsiella pneumoniae/patient's surrounding environment/influencing factor/drug resistance分类
医药卫生引用本文复制引用
张思嘉,张幸,田靓,周毅彬,温晓飒,汪静,徐智寅,吴敏..2021-2023年上海市闵行区某医疗机构肺炎克雷伯菌环境污染风险及耐药性分析[J].上海预防医学,2025,37(4):289-295,7.基金项目
上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科(GWVI-11.1-04) （2023-2025年）
上海市闵行区卫生健康系统公共卫生优秀人才培养项目(20240607) （20240607）
