神经外科重症监护病房多重耐药菌季节性分布特点的探讨

Study on the Seasonal Distribution of Multidrug-resistant Organism in Neurosurgical Intensive Care Unit

目的分析神经外科重症监护病房(NSICU)多重耐药菌流行变化特点,分析其感染与定植状况,为有针对性地制定防控策略提供依据。方法对2014年1月-2015年4月每例入住NSICU的患者,每日主动监测其多重耐药菌的情况。结果共159例患者检出多重耐药菌,共检测出多重耐药菌218株,其中医院感染42例次,检出最多的是多重耐药/泛耐药鲍曼不动杆菌。多重耐药菌定植率与感染发现率呈正相关关系,但1月-12月定植率有明显升高趋势,而多重耐药菌感染发现率无明显趋势变化。结论 NSICU多重耐药菌以定植状态为主,其明显的季节性变化使医院感染风险处于不同的水平,需要医院感染防控专(兼)职人员在多重耐药菌定植率较高的季节提高警惕,及时发出风险预警,强化医院感染风险管理。NSICU鲍曼不动杆菌已成为医院感染防控的头号对象,其明显的季节性分布特点值得更多关注,并加强其医院感染防控措施的落实。

Objective To analyze epidemic characteristics of multidrug-resistant organism（MDRO） in Neurosurgical Intensive Care Unit（NSICU）, and to analyze the status of infection and colonization, in order to provide reference for constituting intervention measures. Methods Patients who stayed in NSICU during January 2014 to April 2015 were actively monitored for the MDRO situation. Results A total of 218 MDRO pathogens were isolated from 159 patients, and 42 cases were healthcare-associated infections（HAI） among 159 patients. The Acinetobacter baumannii was the most common one in the isolated acinetobacter. Colonization rate was positively correlated with the incidence of HAI. From January to December, there was a significantly increase in the colonization rate, but not in the incidence of HAI. Conclusions The main MDRO situation is colonization in NSICU. The obvious seasonal variation makes the HAI risk at different levels. So it is necessary that full-time and part-time HAI control staff be on alert, issue timely risk warning, and strengthen risk management. The Acinetobacter baumannii has become the number one target for HAI prevention and control in NSICU, so their apparent seasonal distribution is worthy of more attention, and strict implementation of HAI prevention and control measures should be carried out.