某外科重症监护病房多重耐药鲍曼不动杆菌定植危险因素分析及传播模型初探

Analysis of Risk Factors and the Dissemination Model of Multidrug-resistant Acinetobacter baumannii Among Patients in a Surgical Intensive Care Unit

目的分析某外科重症监护病房(SICU)多重耐药鲍曼不动杆菌(MRAB)定植的可能危险因素;应用Ross-Macdonald模型(R-S模型)初步模拟SICU内MRAB定植的传播,为单病房MRAB定植的有效控制提供线索。方法从2008年4月7日到2008年7月15日,连续采集入住患者、医护人员、环境标本;应用统一设计的调查问卷收集入住患者基本信息、临床操作、治疗等信息;每日观察病房内的医务人员手卫生执行情况、护理分组情况。结果研究期间该病房内MRAB总定植率为50.79%,其中入ICU后MRAB定植率(33.33%)高于入ICU前(17.46%)(P<0.05)。环境标本MRAB检出率为13.70%。多因素Logistic分析提示,入ICU后MRAB定植的可能独立危险因素仅有住SICU的天数(OR1.34,95%CI1.12～1.60,P<0.01)。观察到的续发病率与模型模拟的数值不一致。结论该SICU内多重耐药鲍曼不动杆菌定植率高,可能存在病房内以及病区间交叉传播;住SICU越久的患者定植MRAB可能性越大;现有的R-S模型不能很好地模拟该病房内MRAB定植的传播。

Objective To analyse risk factors of multidrug-resistant Acinetobacter baumannii（MRAB） colonization in a surgical intensive care unit（SICU）;to model the dissemination of MRAB colonization in the SICU for culling the effective measures of controling MRAB colonization.Methods Patients＇,healthcare works＇ and enviromental samples of the SICU were collected,sequentially,from April 7 to July 15 in 2008.Standardized questionaires were designed for collecting patients＇ demographic informations,clinical informations,procedures and devices informations.Obersvated the healthcare works＇ hands hygiene compliance and nurse cohorts in the SICU.Results 50.79%（32/63） patients were MRAB colonized,and the prevalence of MRAB colonization ≥48h was higher than MRAB colonization ≤48h（33.33% vs 17.46%） in the SICU.The rate of MRAB obtained from the SICU environment was 13.70%.Multiple Logistic regression showed days of SICU stayed was the only independent risk factor of MRAB colonization ≥48h in SICU（OR 1.34,95%CI 1.12～1.60,P0.01）.It was not coincidence between the observed secondary reproduction rate and the reproduction rate computed from the model.Conclusion The prevalence of MRAB colonization was high in the SICU.It maybe due to the cross-transmission that happed in the SICU or in other surgical wards.The longer patients stayed in SICU,the more probalble MRAB colonization.The curent Ross-Macdonald model might not fit the dissemination of MRAB in the SICU.