住院患者多重耐药菌感染的调查及干预措施效果分析

The investigation of multi drug resistant organisms infection in inpatients and analysis of effect of intervention measures

目的探讨住院患者多重耐药菌(MDRO)感染的调查和干预的效果。方法 1793例住院患者,使用实时荧光定量PCR(qPCR)的方法对患者进行菌株分析鉴定。分析多重耐药菌的感染情况,比较干预前后不同科室[妇科、重症监护病房(ICU)、产科、呼吸内科、普外科、泌尿外科、其他科室]感染发生情况和满意度。结果 1793例患者中,检出的耐药菌分别为:耐碳青霉稀类的鲍曼不动杆菌、耐碳青霉稀类的铜绿假单胞菌、耐甲氧西林的金黄色葡萄球菌、耐碳青霉稀类的肺炎克雷伯菌、耐碳青霉稀类的大肠埃希氏菌、耐万古霉素肠球菌株。干预前, ICU感染发生率高于其他科室,差异具有统计学意义(P<0.05);干预后,妇科、ICU、产科、呼吸内科、普外科、泌尿外科、其它科室感染的发生率分别为8.93%、15.53%、8.85%、10.19%、16.46%、27.2%、17.86%,均低于干预前的60.71%、91.29%、83.78%、66.99%、71.84%、76.00%、62.01%,总感染发生率15.06%低于干预前的73.68%,差异均具有统计学意义(P<0.05)。干预后患者满意度为75.63%,高于对照组的38.65%,差异具有统计学意义(P<0.05)。结论住院患者多感染耐碳青霉稀类的鲍曼不动杆菌、耐碳青霉稀类的铜绿假单胞菌、耐甲氧西林的金黄色葡萄球菌、耐碳青霉稀类的肺炎克雷伯菌、耐碳青霉稀类的大肠埃希氏菌、耐万古霉素肠球菌株等耐药菌,尤其是ICU患者发生最多,因此要对其进行重点关注,实施有效的干预可以降低感染的发生,缩短患者的住院时间,提高患者满意度。

Objective To discuss the investigation and intervention effect of multi drug resistant organisms(MDRO) infection. Methods Real-time fluorescent quantitative PCR(qPCR) was used to analyze and identify the strains in 1793 inpatients. The infection situation of multidrug resistance bacteria was analyzed, and and the occurrence of infection of different departments [gynecology, intensive care unit(ICU), obstetrics, respiratory medicine, general surgery, urology and other departments] before and after the intervention and satisfaction degree was compared. Results The drug-resistant bacteria detected in 1793 patients were Acinetobacter baumannii resistant to carbapenema, Pseudomonas aeruginosa resistant to carbapenema, Staphylococcus aureus resistant to methicillin, Klebsiella pneumoniae resistant to carbapenem, Escherichia coli resistant to carbapenem, and Enterococcus resistant to vancomycin. Before intervention, the infection rate of ICU was higher than other departments, and the difference was statistically significant(P<0.05). After intervention, the infection rate of gynecology, ICU, obstetrics, respiratory medicine, general surgery, urology and other departments were 8.93%, 15.53%, 8.85%, 10.19%, 16.46%, 27.2% and 17.86% respectively, which were lower than 60.71%, 91.29%, 83.78%, 66.99%, 71.84%, 76.00% and 62.01% before intervention, and total infection rate 15.06% was lower than 73.68% before intervention, and their difference was statistically significant(P<0.05). The satisfaction degree was 75.63%, which was higher than 38.65% before intervention, and the difference was statistically significant(P<0.05). Conclusion Inpatients are more likely to be infected with Acinetobacter baumannii resistant to carbapenem, Pseudomonas aeruginosa resistant to carbapenem, Staphylococcus aureus resistant to methicillin, Klebsiella pneumoniae resistant to carbapenem, Escherichia coli resistant to carbapenem, and Enterococcus resistant to vancomycin, especially in ICU. Therefore, more attention should be payed to them and effective intervention can reduce the incidence of infection, shorten the hospitaliztion time, and improve satisfaction degree of patients.