外科重症监护病房多重耐药鲍曼不动杆菌交叉感染的防控效果和临床特征分析

Analysis of effects of prevention and control and clinical features of cross-infection of multi-drug resistant Acinetobacter baumannii in surgery intensive care unit

目的评估降阶梯防控策略在外科重症监护病房控制多重耐药鲍曼不动杆菌(MDRAB)交叉感染的效果,分析菌株特点和定植/感染的临床特征。方法对上海交通大学医学院附属瑞金医院外科重症监护病房2013年8月—2014年7月收治的所有患者实施动态细菌学监测和降阶梯防控措施,分析防控效果、菌株特点和临床参数。结果共检出49株MDRAB,对各类抗菌药物均高度耐药,其中定植菌32株(占65.3%),感染菌17株(占34.7%);MDRAB整体检出率与重症监护病房内获得率均呈显著下降趋势(P<0.001);MDRAB定植/感染患者的入科前碳青霉烯类抗生素使用率、入科APACHEⅡ评分与休克、急性呼吸功能衰竭、急性肾损伤及机械通气的发生率显著高于无MDRAB定植/感染患者(P<0.05),但MDRAB定植与感染患者的临床特征比较,差异无统计学意义(P>0.05)。结论临床上难以通过高危因素分析预测MDRAB的感染,但通过高危因素分级,在外科重症监护病房内开展降阶梯防控策略,仍可以有效地控制耐药菌的播散,降低重症监护病房内MDRAB的交叉感染率。

Objective To evaluate the effect of de-escalation prevention and control strategy on controlling the cross-infection of multi-drug resistant Acinetobacter baumannii（MDRAB） in surgery intensive care unit（SICU） and analyze characteristics of strains and clinical features of colonization and infection.Methods The active bacterial surveillance and the de-escalation prevention and control strategy were carried out for all patients admitted in SICU of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from August 2013 to July 2014.Effects of prevention and control,characteristics of strains,and clinical parameters were analyzed.Results A total of 49 strains of MDRAB with high antibiotic resistance were isolated and 32（65.3%） of them were strains of colonization and 17（34.7%） of them were strains of infection.Both overall detection rate and SICU acquired rate of MDRAB significantly decreased（P〈0.001）.The administration rate of carbapenem before admission and incidence of high APACHE Ⅱ score,shock,acute respiratory dysfunction,acute kidney injury and mechanical ventilation of patients with MDRAB colonization/infection were significantly higher than those of patients without M DRAB colonization/infection（P〈0.05）.However,the differences of clinical features between patients with MDRAB colonization and patients with MDRAB infection were not statistically significant（P〈0.05）.Conclusion It is difficult to analyze and predict the MDRAB infection based on clinical high risk factors.However,the spread of drug resistant bacteria can be efficiently controlled and cross-infection rate of MDRAB in SICU can be decreased by classification of high risk factors and application of de-escalation prevention and control strategy.