ICU标准化建设对其病原菌流行病学的影响

Effect of standardization of ICU on bacterial epidemiology

目的探讨重症监护病房(ICU)标准化建设,对其病原菌流行病学的影响。方法采用回顾性对照分析的方法,比较医院ICU标准化建设前后年内相同时间段ICU病原菌流行病学的变化。结果与2008年7-12月非标准化ICU相比,2009年7-12月标准化建设的ICU其收治患者的性别、平均年龄和APACHEⅡ评分比较,两者差异无统计学意义;标准化ICU床位数较前增加1倍,临床分离菌株数由702株增加至1794株;主要为呼吸道和胸、腹腔引流液,菌株来源无明显变化;但标准化建设后血源性菌株检出率由18株上升至87株、革兰阳性菌检出率由245株下降至127株、革兰阴性菌检出率由509株上升至1444株,差异均有统计学意义(均P<0.05);金黄色葡萄球菌、屎肠球菌分离率明显下降。结论 ICU标准化建设对病原菌流行病学有明显的影响,明显减少了金黄色葡萄球菌和屎肠球菌的检出率,在医院感染的控制和经验性治疗工作中应引起关注。

OBJECTIVE To explore the effect of standardization of ICU on bacterial epidemiology.METHODS By means of retrospective analysis,the changes in the bacterial epidemiology before and after standardization of ICU were compared.RESULTS Data of patients before standardization of ICU from Jul.to Dec.2008 were compared with those after standardization of ICU from Jul.to Dec.2009.There were no significant differences in patients′ sex,average age,and APACHE Ⅱ scores.The number of beds in standardization ICU showed a 1-fold increase,and the isolated strains increased from 702 isolates to 1794 isolates.They were mainly isolated from drainage fluid of respiratory tract and thoracic cavity,with no significant change in specimen sources;however,after the standardization of ICU,blood-borne strains increased from 18 strains to 87 strains,the isolated gram-positive bacteria decreased from 245 strains to 127 strains,and gram-negative bacteria increased from 509 strains to 1444 strains（P〈0.05）.The isolation rates of Staphylococcus aureus and Enterococcus faecium were significantly decreased.CONCLUSION The standardization of ICU has significant effect on the bacterial epidemiology,reducing the detection rates of S.aureus and E.faecium significantly.Great importance should be attached to the control of nosocomial infections and empirical treatments.