Evaluation And Analysis Of Different Methods For Disinfection Of Duodenoscope For Patients With Multi-drug Resistant Bacteria Infection

Objective:Evaluation of different methods for multiple drug-resistant bacteria infection in patients with duodenal the disinfection effect of the mirror,and monitoring after disinfection of bacteria resistant levels of disinfectant and disinfectant resistance genes carry case,analysis for multiple drug-resistant bacteria infection in patients with duodenal mirror the cause of the disinfection is not complete,in order to make the disinfection is more safe and effective.Methods:（I）Evaluate the disinfection effects of different methods for patients with multi-drug resistant bacteria infection using duodenoscopeArticle 1.The collected 160 A 3 armour hospital endoscopy center in jiangxi province multi-resistant bacteria infection of patients with duodenal mirror,randomly divided into 4 groups,each group 40,were separately glutaraldehyde high-level disinfection（group A）,peracetic acid（group B）,glutaraldehyde repeated high levels（group C）and ethylene oxide disinfection（group D）;2.Field sampling was carried out for 4 groups of disinfected and sterilized duodenoscopic biopsy cavity,water air cavity and forceps lifting cavity,with repeated sampling for 3 times,and a total of 1440 samples were obtained.Microbial detection was performed to compare the results of microorganism detection in the 4 groups;3.The automatic microbial analysis system was used to identify the bacteria detected after disinfection,and the pathogen with the highest detection rate was tested by drug sensitivity test to detect its drug resistance.（2）The disinfectant resistance level of multi-drug resistant Pseudomonas aeruginosa and the carrying status of disinfectant resistance genes were detected1.The minimum inhibitory concentration test and the minimum bactericidal concentration of multi-drug resistant Pseudomonas aeruginosa strains were detected by2.5%glutaraldehyde and 0.24%peracetic acid;2.Primers,AGAR gel electrophoresis and PCR were designed to detect the presence of five disinfectant resistant genes in the multi-drug resistant Pseudomonas aeruginosa strains,including qac A/B、qac C/D、qac E、qac ED1 and qac ED1-sul1.Results:（I）Evaluate the disinfection effects of different methods for patients with multi-drug resistant bacteria infection using duodenoscope1.Microbial detection results:160 duodenoscopes were collected in this study and divided into 4 groups with 40 in each group and 3 lumens in each duodenoscope.The test was repeated 3 times,and 1440 samples were detected.The total positive lines of duodenoscopic lumen in group D were the lowest（0）,and the total positive lines of duodenoscopic lumen in group A,B and C were 78,36 and 60,respectively,with statistical significance among the four groups（c²=89.191,P=0.000）.The results of the detection rate of 160 duodenoscopic microorganisms showed that the total detection rate of group A was 32.5%,group B was 27.5%,group C was 27.5%,and group D was0%.The difference between the four groups was statistically significant（c²=38.657,P=0.000）.The median and quartile results of microorganism detection showed that in the biopsy cavity,the value of group A was 0（0,1）,and that of the other three groups was 0（0,0）,and the difference between the four groups was statistically significant(H _activity=15.687,P=0.001).In the water cavity,the value of group A was 0（0,0.75）,and that of the other three groups was 0（0,0）,and the difference between the four groups was statistically significant(H _water=11.604,P=0.009).In the forceps lifting lumen,group A was 0（0,2.5）,group B and group C were 0（0,1）,and group D was 0（0,0）,and the difference between the four groups was statistically significant(H _lift=15.371,P=0.009).2.Bacterial identification and drug sensitivity results:In this study,a total of 97strains of pathogenic bacteria were isolated from 1440 individuals,10 types of pathogenic bacteria were detected,and the detection rate was 6.7%,among which the detection rate of multi-drug resistant Pseudomonas aeruginosa ranked first.（2）Detect the disinfectant resistance level of multi-drug resistant bacteria and the carrying status of disinfectant resistance genes1.The MIC and MBC values of standard Pseudomonas aeruginosa ATCC 27853against glutaraldehyde were 10000mg/L.MIC values of 37 strains of multidrug-resistant Pseudomonas aeruginosa against glutaraldehyde ranged from 10000 to24000mg/L,with a median of 24000mg/L and a interquartile interval of 6000mg/L.The MBC range of glutaraldehyde to 37 strains of multi-drug resistant Pseudomonas aeruginosa was 12000～24000mg/L,with a median of 24000mg/L and a interquartile interval of 0mg/L.The difference between the two groups was statistically significant（Z=-2.808,P=0.005）.The MIC value and MBC value of the standard strain for peracetic acid were 500mg/L.MIC values of 37 strains of multidrug-resistant Pseudomonas aeruginosa for peracetic acid ranged from 200 to 800mg/L,with an average of 500mg/L and a standard deviation of 188.56mg/L.The MBC values of 37strains of multidrug-resistant Pseudomonas aeruginosa were in the range of 200～800mg/L,with the mean value of 597.30 mg/L and the standard deviation of172.38mg/L.The difference between the two groups was statistically significant（Z=-2.209,P=0.027）.2.Using the MIC value of the standard strain as the resistance standard,there were36 strains of multi-drug resistant Pseudomonas aeruginosa which were resistant to glutaraldehyde,and the resistance rate was 97.30%.Thirteen strains of Pseudomonas aeruginosa were resistant to peracetic acid,and the resistance rate was 35.13%.The resistance rate of multi-drug resistant Pseudomonas aeruginosa to glutaraldehyde was higher than that to para-peracetic acid（c²=31.956,P=0.000）.With standard strains of MBC value of resistance,resistant to glutaraldehyde multiple drug resistance has 37strains of pseudomonas aeruginosa,the resistance rate was 100%,the right oxygen ethanoic acid resistant of multiple drug resistance has 26 strains of pseudomonas aeruginosa,the resistance rate was 70.27%,the multiple drug resistance pseudomonas aeruginosa to glutaraldehyde resistance rate higher than acetic acid peroxide（c²=12.921,P=0.000）.3.The carrying status of disinfectant resistant genes:Among the 37 strains of multi-drug resistant Pseudomonas aeruginosa,the detection rate of qac C/D gene was72.9%,the detection rate of qac ED1-sul1 gene was 54.05%,and the strains carrying qac C/D+qac ED1-sul1 accounted for 40.54%.qac A/B、qac E and qac ED1 genes were not detected.Conclusion:1.The disinfection effect of ethylene oxide and peracetic acid is better than that of high level disinfection of glutaraldehyde and repeated high level disinfection of glutaraldehyde.In the process of chemical immersion disinfection,it is difficult to disinfect and sterilize the lumen of duodenoscope lifting forceps.2.Multi-drug resistant Pseudomonas aeruginosa is the most commonly detected pathogen after chemical immersion disinfection in duodenoscopy for patients with multi-drug resistant bacteria infection.3.The resistance rate of multi-drug resistant Pseudomonas aeruginosa to 2.5%glutaraldehyde is very high,so duodenoscopic chemical immersion disinfection treatment of glutaraldehyde for patients infected with multi-drug resistant bacteria is not recommended.Multidrug-resistant Pseudomonas aeruginosa was also resistant to0.24%peracetic acid,which should be paid attention to in clinical practice.4.qac C/D and qac ED1-sul1 disinfectant resistance gene is an important reason for the high bacterial detection rate after chemical immersion disinfection of duodenoscope used for patients with multi-drug resistant bacteria infection.