县市级医院综合ICU多药耐药菌主动筛查结果分析

Result of active screening of multidrug-resistant bacteria in general ICU of country-level hospital

目的了解县市级医院综合ICU多药耐药菌(MDROs)的定植/感染状况及相关危险因素,为制定科学有效的预防控制策略提供依据。方法收集所有入组患者的咽拭子和人工气道吸痰标本,采样时间为入住ICU 24h内、第4天、第8天及以后每7d;两种标本均筛选MDROs,进行菌株鉴定及药敏测试;分析MDROs定植/感染、分布、变迁及相关危险因素;采用SAS 9.3软件进行统计分析,计数资料采用χ2检验。结果筛查152例患者,检出MDROs 59株,其中前3位为鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌分别占47.6%、20.3%、13.6%;MDROs定植以金黄色葡萄球菌为多,占36.4%,MDROs感染以鲍氏不动杆菌为多,占52.8%;入住ICU 24h内、第4天、第8天、≥15dMDROs检出分别占13.2%、22.4%、48.4%、52.2%,呈线性上升趋势(P<0.01)。结论县市级医院综合ICU患者入住24h内及24h后均有MDROs的定植及感染;MDROs感染的重要病原菌是鲍氏不动杆菌;MDROs检出率随入住ICU时间延长而逐渐上升;应严格掌握气管插管指征,及早评估拔管,降低患者MDROs感染率。

OBJECTIVE To understand the related risk factors for colonization or infection with multidrug-resistant organisms （MDROs） in general ICU of country-level hospital so as to formulate the scientific combination preven- tion and control strategies. METHODS The throat swabs and artificial airway sputum specimens were collected from all the patients enrolled in the study, the specimens were respectively sampled at admission to ICU within 24 hours, day 4, day 8, and every 7 days, both specimens were screened for MDROs, the identification and drug susceptibility testing were performed, the MDROs colonization or infection, distribution, change, and related risk factors were analyzed, the statistical analysis was performed with the use of SAS 9.3 software, and the count data were analyzed by means of the chi-square test. RESULTS Totally 152 patients were screened, from which 59 strains of MDROs were isolated; the Acinetobacter baurnannii, Staphylococcus aureus, and Klebsiella pneurnoni- ae ranked the top three species, accounting for 47.6%, 20.3%, and 13.6%, respectively. 36.4% of the colonized MDROs were the S. a.ureus strain, 52.8% of the MDROs causing the infections were the A. baurnannii strains. The constituent ratio of the isolated MDROs was 13.2% at the admission to ICU within 24 hours, 22.4% on day 4, 48.4% on day 8, 52. 2% no less than 15 days after the admission, showing an upward trend （P〈0.01）. CONCLUSION The MDROs colonization and infection are prevalent in the general ICU patients of country-level hospitals at the admission to the ICU within 24 hours and more than 24 hours after the admission. The A. baurnan- nii is the predominant species of MDROs causing the infections; the isolation rate of the MDROs is increased as the length of ICU stay extends. It is necessary to strictly master the indications for endotracheal intubation and as- sess the extubation in a timely manner so as to reduce the incidence of MDROs infections.