2008年与2011年某综合医院外科ICU多药耐药菌主动监测培养结果分析

Active surveillance of multidrug-resistant organisms in SICU in a general hospital in 2008 and 2011

目的了解2008年和2011年上海中山医院外科ICU患者多药耐药菌(MDROs)的定植情况。方法患者进入ICU时(第1天)、第4天、每周和离开ICU时分别采集鼻拭和直肠拭子标本,使用生物梅里埃公司提供的耐药菌显色培养基,对鼻拭和直肠拭子标本分别进行耐甲氧西林金黄色葡萄球菌(MRSA)和产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌(ESBL+Eco/Klp)的筛查。结果 2008年和2011年鼻拭标本中MRSA检出率分别为5.0%和7.2%,直肠拭子中ESBL+Eco/Klp检出率分别为35.0%和42.0%;2008年入ICU时MRSA/ES-BL+Eco/Klp的定植率为39.7%,出ICU时为47.4%,2011年则分别上升至49.3%和58.9%,2008年入住ICU第3～4天,MRSA获得的定植率为9.7%,入住5～7 d后上升为22.7%;2011年分别为16.3%和22.2%,2008年在相应时间段获得ESBL+Eco/Klp定植率分别是13.0%和40.0%;2011年则为7.7%和40.0%。结论 2011年ICU的MRSA/ESBL+Eco/Klp的检出率和定植率比2008年明显上升;定植率随着入住ICU时间的延长显著增加。

OBJECTIVE To evaluate the colonization of multidrug-resistant organisms in SICU patients in a general hospital in 2008 and 2011.METHODS Nasal and rectal swabs of the patients were collected on the time of the admission day,the forth day,every week after admission and the discharge day.Using chromogenic culture media,multidrug-resistant Staphylococcus aureus（MRSA） were monitored from nasal swabs,and extended-spetrum β-lactamase-producing Escherichia coli/Klebsiella pneumoniae（ESBL＋ ECO/Klp） were isolated from rectal swabs.RESULTS The detection rates of MRSA from nasal swabs,ESBL＋ Eco/Klp from rectal swabs were 5.0%,35.0% in 2008 and 7.2%,42.0% respectively in 2011.The colonization rates of MDROs were 39.7% at admission and 47.4% at discharge in 2008,while which were 49.3% and 58.9% in 2011.The acquired colonization rates of MRSA,ESBL＋ Eco/Klp on the 3rd-4th day in ICU were 9.7%,13.0% in 2008;and 16.3%,7.7% in 2011.However,the acquired colonization rates on the 5th-7th day rose up to 22.7%,40.0% respectively in 2008,and 22.2%,40.0%,respectively in 2011.CONCLUSIONS The detection rate and colonization rate of MRSA/ESBL＋Eco/Klp in ICU in 2011 is markedly higher than that in 2008;the MRSA colonization rate increases significantly as ICU stay time extends.