综合医院多药耐药菌高风险患者主动筛查培养调查分析

Active surveillance of multidrug-resistant organisms in high risk patients in a general hospital

目的了解综合性医院多药耐药菌(MDROs)高风险住院患者的定植,为采取预防与控制措施提供科学依据。方法对各科室不同住院时间多药耐药菌高风险的153例住院患者,分别采集鼻拭子和直肠拭子标本,使用法国生物梅里埃公司提供的耐药菌显色培养基,对鼻拭子和直肠拭子标本分别进行耐甲氧西林金黄色葡萄球菌(MRSA)、产超广谱β-内酰胺酶大肠埃希菌(ESBLs+ECO)和肺炎克雷伯菌(ESBLs+KPN)的筛查。结果 MR-SA、ESBLs+ECO和ESBLs+KPN定植率分别为17.6%、53.6%和17.0%;对4组MRSA检出数进行卡方检验,结果显示,住院时间≥21d组与其他3组比较MRSA定植率明显上升;对4组ESBLs+ECO数据进行比较,随着住院时间延长ESBLs+ECO定植率逐渐上升,差异有统计学意义(χ2趋势=11.836,P<0.01),ESBLs+KPN的定植率不随住院时间延长而增加,差异无统计学意义。结论住院时间≥21dMRSA定植率明显上升,ESBLs+ECO定植率随住院时间延长逐渐上升,ESBLs+KPN的定植率不随住院时间延长而增加。

OBJECTIVE To evaluate the colonization of multidrug-resistant organisms （MDROs） in high risk hospitalized patients so as to provide scientific clata for preventing and controlling nosocomial infections. METHODS The nasal and rectal swabs from 153 hospitalized patients were collected from different departments at different time. The swabs were screened for methicillin-resistant Staphylococcus aureus （MRSA） and the extend- ed spectrum β-1actamase-producing （ESBLs） Escherichia coli and Klebsiella pneumoniae by using multidrug- resistant chromogenic culture media offered by BioM6 rieux. RESULTS The colonization rates of MRSA, ESBLs- producing E. coli, and ESBLs-producing K. pneumoniae were 17.60%, 53. 6%, and 17.0%, respectively. The colonizations of MRSA in four different groups were analyzed by chi-square test, suggesting an distinctly increasing colonization rate in patients with the hospitalization more than 21 days. The comparison of colonization of ESBLs-producing E. coli in the four groups showed that the colonization rate increased significantly with the prolonged hospitalization, the difference was statistically significant （x2= 11. 836, P〈0.01）; however, the colo- nization rate of the ESBLs-producing K. pneumoniae kept invariable with prolonged hospitalization, the difference was not statistically significant. CONCLUSION The colonization rate of MRSA is increased significantly when the duration of hospitalization is more than 21 days; the colonization rate of ESBLs-producing E. coli keeps an upward trend with the prolonged hospitalization duration, while the colonization rate of ESBLs-producing K. pneumoniae keeps invariable with the prolonged hospitalization duration..