【摘要】 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;χ~2=8.013,P=0.005;χ~2=13.607,P=0.001;χ~2=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。更多还原

【Abstract】 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 identi?ed 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 signi?cant 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% vs28.0%)(all P < 0.05). In addition to the above risk factors, the cases colonized with Staphylococcus aureus had signi?cant 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 bene?cial for reducing the nasal colonization rate of pathogens.更多还原