ICU患者呼吸道多药耐药菌定植及感染状况前瞻性调查研究

Prospective investigation of multi-drug resistant bacteria colonization and infection conditions of patients treated with respiratory tract in ICU

目的探讨重症监护室(ICU)患者呼吸道多药耐药菌定植及感染状况,为医院感染的预防控制提供参考。方法选取2014年1月-2016年6月在医院ICU住院治疗100例患者,采集患者入ICU第1天、第7天时咽试子或人工气道吸痰标本共324份,进行病原菌培养,筛查耐超广谱β-内酰胺酶(ESBLs)大肠埃希菌、耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类肺炎克雷伯菌(CRKP)、ESBLs肺炎克雷伯菌。结果入ICU第1天分离出多药耐药菌78株,其中ESBLs大肠埃希菌57株、MRSA 14株、CRKP 5株、ESBLs肺炎克雷伯菌2株,分别占73.08%、17.95%、6.41%、2.56%,第7天分离出多药耐药菌112株,其中ESBLs大肠埃希菌72株、MRSA 21株、CRKP 11株、ESBLs肺炎克雷伯菌8株,分别占64.29%、18.75%、9.82%、7.14%;入ICU第1天分离ESBLs大肠埃希菌、MRSA、CRKP、ESBLs肺炎克雷伯菌感染率分别为63.16%、50.00%、20.00%、0,定植率分别为36.84%、50.00%、80.00%、100.00%,第7天分离ESBLs大肠埃希菌、MRSA、CRKP、ESBLs肺炎克雷伯菌感染率分别为79.17%、85.71%、81.82%、87.50%,定植率分别为20.83%、14.29%、18.18%、12.50%;入ICU第7天时患者呼吸道多药耐药菌感染率明显高于第1天时,比较差异有统计学意义(P<0.05)。结论 ICU患者呼吸道定植及感染的多药耐药菌主要是ESBLs大肠埃希菌,随着住院时间延长多药耐药菌感染率明显增加。

OBJECTIVE To discuss multi-drug resistant bacteria colonization and infection condition of patients treated with respiratory tract in ICU,so as to provide references for the prevention and control of nosocomial infections.METHODS A total of 100 patients hospitalized with ICU from Jan.2014 to Jun.2016 were selected.Totally 324 specimens of throat swab or artificial airway sputum suction on the 1st d and 7th d were collected.Pathogenic bacteria were cultured,and Escherichia coli and Klebsiella pneumonia producing extended spectrumβ-lactamases（ESBLs）,methicillin-resistant Staphylococcus aureus（MRSA）,and carbapenem-resistant Klebsiella pneumoniae（CRKP）were screened.RESULTS Totally 78 strains of multi-drug resistant bacteria were isolated on the 1st d,including 57 strains of ESBLs E.coli,14 strains of MRSA,5strains of CRKP,and 2strains of ESBLs K.pneumonia,accounting for 73.08%,17.95%,6.41% and 2.56%,respectively.Totally 112 strains of multiresistant bacteria were isolated on the 7th d,including 72 strains of ESBLs E.coli,21 strains of MRSA,11 strains of CRKP,and 8strains of ESBLs K.pneumonia,accounting for 64.29%,18.75%,9.82% and 7.14%,respectively.The infection rates of ESBLs E.coli,MRSA,CRKP,ESBLs K.pneumonia were 63.16%,50.00%,20.00% and 0on the 1st d,the colonization rates were 36.84%,50.00%,80.00%and 100.00% on the1 st d,and the infection rates were 79.17%,85.71%,81.82% and 87.50% on the 7th d,colonization rates were20.83%,14.29%,18.18% and 12.50% on the 7th d.Multi-drug resistant bacteria infection rates on the 7th d were significantly higher than those on the 1st d（P〈0.05）.CONCLUSION ESBLs E.coli was the major multidrug resistant bacteria which leads to colonization and infection in ICU patients.The multi-drug resistant bacteria infection rates significantly increase with the time extension of the hospitalization.