某院2016-2018年ICU多重耐药菌医院感染特点分析

Characteristic of Hospital-Associated Infection in ICU with Multidrug-Resistant Organisms in a hospital from 2016 to 2018

目的:分析重症监护病区(Intensive Care Unit,ICU)多重耐药菌医院感染特点,为多重耐药菌医院感染防控提供依据。方法:对ICU多重耐药菌医院感染发生情况进行前瞻性监测,描述性分析2016-2018年ICU多重耐药菌医院感染发生情况、菌株构成以及感染部位分布,比较不同多重耐药菌菌株的医院感染部位构成、不同类型I CU分布的区别。结果:2016-2018年I CU共发生多重耐药菌医院感染197例次,医院感染发生率为2.73%、千住院日医院感染率为5.40‰;耐碳青霉烯类鲍曼不动杆菌为外科、呼吸和心外ICU最常见的多重耐药菌医院感染菌株,急诊ICU最常见的多重耐药菌医院感染菌株为耐碳青霉烯类肠杆菌科细菌;ICU多重耐药菌医院感染菌株构成:耐碳青霉烯类鲍曼不动杆菌59.39%,耐碳青霉烯类肠杆菌科细菌20.81%,耐碳青霉烯类铜绿假单胞菌16.75%,耐甲氧西林金黄色葡萄球菌3.05%;多重耐药菌的医院感染部位以呼吸系统、血流感染和切口感染为主,其中耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类肠杆菌科细菌和耐碳青霉烯类铜绿假单胞菌的医院感染主要发生于呼吸系统,耐甲氧西林金黄色葡萄球菌医院感染部位以血流感染为主,泌尿道感染的常见多重耐药菌为耐碳青霉烯类肠杆菌科细菌。结论:ICU是多重耐药菌医院感染高发科室,应根据医院感染特点,在诊疗护理中采取针对性防控措施,尤其是对重点菌株及其重点部位医院感染的监测与防控。

Objective:To understand the characteristics of Hospital-Associated Infection(HAI)with Multidrug-Resistant Organisms(MDRO)in Intensive Care Unit(ICU),and to provide evidence for prevention and control of HAI with MDRO.Methods:Prospective surveillance of HAIs with MDRO was performed from 2016 to 2018 in ICU.Descriptive analysis the incidence,strain composition and distribution of infection sites of HAIs with MDRO in ICU,comparing the composition of hospital infection sites and the distribution of different types of ICUs in different MDRO strains.Results:There were 197 cases of HAIs with MDRO in ICU from 2016 to 2018.The incidence of HAI was 2.73%and 5.40‰/1000-hospitalization day.CRAB was the most common MDRO in surgical,respiratory and cardiac surgery ICU.The most common MDRO strain in emergency ICU was CRE.ICU MDRO strain consisted of CRAB 59.39%,CRE 20.81%,CRPA 16.75%,MRSA 3.05%.The HAIs of MDRO were mainly in respiratory system,bloodstream,and wound.The HAIs of CRAB,CRE and CRPA mainly occurred in the respiratory system.The infection of MRSA was mainly caused by bloodstream infection.CRE was common in urinary tract infections.Conclusion:ICU is a high-risk department for MDRO.According to the characteristics of HAI,targeted prevention and control measures should be taken,especially the monitoring and prevention of key strains and sites.