普遍去定植策略在儿科重症监护室应用的回顾性研究

A retrospective study of the application of universal decolonization strategy in Pediatric Intensive Care Unit

目的:分析葡萄糖酸氯己定溶液作为普遍去定植策略在PICU应用的效果。方法:回顾性分析选择2013年12月至2019年5月1?184例有定植菌的患者为研究对象,其中对照组为2013年12月至2016年11月未实施普遍去定植策略,在PICU住院期间检测到定植菌感染的病例;实验组为2016年12月至2019年5月应用普遍去定植策略后测到定植菌感染的病例。比较两组一般资料,定植菌的发生率、种类和存在部位及期间器械相关性感染的发生率。结果:实验组与对照组在住院天数、住院费用方面有统计学差异(P<0.05);普遍去定植策略可以降低定植菌的发生率,差异有统计学意义(P<0.05),尤其是降低铜绿假单胞菌的定植率;多重耐药菌最主要的定植部位是下呼吸道;实验组与对照组的呼吸机相关感染发生率(4.9‰,1.98‰)有统计学差异(P<0.05)。结论:下呼吸道是定植菌检出最高的部位,使用葡萄糖酸氯己定普遍去定植策略能够减少ICU定植菌发生率,尤其是减少铜绿假单胞菌的定植,可以作为预防呼吸机相关性肺炎集束化管理中的一项举措。

Objective:To analyze the effect of chlorhexidine gluconate solution as a universal decolonization strategy in pediatric ICU.Methods:Totally 1184 pediatric patients with bacteria monitored during hospitalization were analyzed retrospectively.The patients who did not receive the universal decolonization strategy from December 2013 to November 2016 were included in the control group.The patients who were performed the universal decolonization strategy from December 2016 to May 2019 were included in the experimental group.The general data of patients,the incidence,the type and location of bacteria,and the incidence of instrument related infection were compared between the two groups.Results:There were significant differences in hospitalization days and hospitalization expenses between the two groups.The incidence of colonized bacteria infection in the experiment group was decreased and the difference was statistically significant(P<0.05).The lower respiratory tract was the main site of pathogen colonization.There was significant difference in the incidence of ventilator-related infection between the two groups(4.9‰,1.98‰,P<0.05).Conclusion:The lower respiratory tract is the site with the highest detection rate of colonization bacteria.The universal decolonization strategy with chlorhexidine gluconate can reduce the incidence of colonization bacteria including Pseudomonas aeruginosa.The universal decolonization strategy can be recommended in the management of ventilator-associated pneumonia.