主动筛查与预防控制措施对ICU患者多药耐药菌感染的影响

Impact of active screening and prevention measures on multidrug-resistant organisms infections in ICU patients

目的评估主动筛查(ASC)结合接触隔离、普遍去定植措施在预防控制重症监护病房(ICU)多药耐药菌(MDROs)感染的效果。方法 2013年1月1日-2014年12月31日对入住综合ICU估计住院日>48h的患者1 373例进行ASC,其中干预前560例、干预后813例;监测MDROs阳性检出率及感染率,对MDROs阳性定植患者进行接触隔离措施,比较干预前后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)、产ESBLs肺炎克雷伯菌(ESBLs-KPN)的医院感染率。结果患者干预前入ICU时ASC的MRSA、ESBLs-ECO、ESBLs-KPN检出率分别为3.04%、51.61%、14.11%,干预后分别为2.95%、55.10%、15.62%,干预措施前后MDROs阳性检出率差异无统计学意义;与ASC阴性患者相比,ASC阳性患者更易获得相应细菌的ICU感染;干预前MRSA、ESBLs-ECO、ESBLs-KPN的日感染率分别为3.37‰、3.37‰、3.55‰,干预后日感染率分别为1.38‰、1.53‰、1.69‰,差异均有统计学意义(P<0.05)。结论 ASC结合接触隔离、普遍去定植措施能有效降低MRSA、ESBLs-ECO、ESBLs-KPN的ICU感染率。

OBJECTIVE To evaluate the effects of active screening （ASC） combined with contacting isolation and universal decolonization on prevention of multidrug‐resistant organisms （MDROs） infections in the intensive care unit （ICU） .METHODS The ASC wad conducted for 1 373 patients who were hospitalized the integrated ICU for an estimation of more then 48 hours from Jan 1 ,2013 to Dec 31 ,2014 ,including 560 cases who did not take interventions and 813 cases who took interventions .The positive rates of detection of MDROs and the infection rates were monitored ,the contacting isolation measures were taken for the patients who were positive for coloniza‐tion of MDROs ,and the incidence rates of nosocomial infections with methicillin‐resistant Staphylococcus aureus （MRSA） ,extended‐spectrum β‐lactamase （ESBL）‐producing Escherichia coli ,and ESBLs‐producing Klebsiella pneumoniae were observed and compared before and after the implementation of interventions .RESULTS Before the implementation of interventions , the detection rates of MRSA , ESBLs‐producing E .coli , and ESBLs‐producing K .pneumoniae were respectively 3 .04% ,51 .61% ,and 14 .11% at the admission to the ICU and were respectively 2 .95% ,55 .10% ,and 15 .62% after the implementation of interventions ,and there was no significant difference in the positive rate of detection of MDROs before and after the implementation of interventions .As compared with the ASC‐negative patients ,the ASC‐positive patients were more likely to be infected with the corresponding bacteria .The daily incidence rates of the infections with MRSA ,EBBLs‐producing E .coli ,and ESBLs‐producing K .pneumoniae were respectively 3 .37‰ ,3 .37‰ ,and 3 .55‰ before the implementation of in‐terventions and were respectively 1 .38‰ ,1 .53‰ ,and 1 .69‰ after the implementation of interventions ,and there was significant difference （P〈0 .05） .CONCLUSION The ASC combined with contacting isolation and uni‐versal decolonization can effectively reduce the incidence rates of the infections with MRSA ,ESBLs‐producing E . coli ,and ESBLs‐producing K .pneumoniae .