ICU多药耐药菌主动筛查结果与危险因素分析

Active screening of multidrug-resistant organisms in ICU and analysis of risk factors

目的分析重症监护病房(ICU)多药耐药菌(MDROs)主动筛查结果,为制定预防控制方案提供参考依据。方法前瞻性研究2013年7月1日-2014年12月31日869例综合ICU住院患者临床资料,主动筛查其出入ICU时MDROs阳性率,分析MDROs定植/感染的危险因素,所有数据采用SPSS18.0软件进行统计分析。结果364例患者入ICU时检出MDROs阳性率为41.89%,出ICU时增至500例检出MDROs阳性率为57.54%(P<0.01);细菌种类均以产超广谱β-内酰胺酶大肠埃希菌(ESBLs-ECO)为主,多因素logistics回归分析显示,ICU住院时间、患者来源、导尿管的使用、入住非感染控制护士管理的床位为MDROs定植/感染的危险因素(P<0.05)。结论 MDROs极易在ICU传播,住院时间、患者来源、导尿管的使用、入住非感染控制护士管理的床位与MDROs定植/感染有关。

OBJECTIVE To analyze the results of active screening of multidrug-resistant organisms（MDROs）in the intensive care unit（ICU）so as to put forward the prevention measures.METHODS A prospective study was conducted for the clinical data of 869 patients who were hospitalized the general ICUs from Jul 1,2013 to Dec 31,2014.The positive rates of MDROs were actively screened at admission or discharge from the ICU,the risk factors for MDROs colonization or infections were analyzed,and the statistical analysis of all the data was performed with the use of SPSS18.0software.RESULTS A total of 364 patients were detected positive for the MDROs at the admission to the ICU,with the positive rate of 41.89%,increasing to 500 cases at the discharge from the ICU,with the positive rate of 57.54%（P〈0.01）.The extended-spectrumβ-lactamases（ESBLs）-producing Escherichia coli was dominant among the MDROs.The multivariate logistics regression analysis indicated that the risk factors for the MDROs colonication or infections included the ICU stay,sources of patients,use of urinary catheter,and beds not being taken charged by infection control nurses（P〈0.05）.CONCLUSION The MDROs are prone to transmit in the ICU.The prevalence of the MDROs colonization or infections is associated with length of hospital stay,sources of patients,use of urinary catheter,and beds not being taken charged by infection control nurses.