304例耐碳青霉烯类肠杆菌科细菌医院感染流行病学特征与干预措施及效果

Epidemiological characteristics of nosocomial infection of 304 cases caused by carbapenem-resistant Enterobacteriaceae and effect of intervention measures

目的 了解耐碳青霉烯类肠杆菌科细菌(CRE)医院感染流行病学特征并对干预措施效果进行评价。方法 采用医院感染监测系统收集2014年1月-2020年12月检出CRE患者信息并进行流行病学特征分析,并建立“感控+临床+医技”多学科协作干预模式,遏制CRE感染的增长。结果 7年共监测住院患者634 228例,CRE医院感染304例,感染发现率为0.048%。不同年份及季度CRE感染呈现波动性;男性CRE感染发现率高于女性(χ^(2)=54.40,P<0.001),≥65岁老年患者CRE感染发现率为<65岁患者的3.10倍(χ^(2)=102.91,P<0.001),感染部位以下呼吸道为主,占59.54%,病原菌以肺炎克雷伯菌为主,占总体79.93%。科室分布以ICU为主,占50.66%。干预后,CRE感染发现率由0.070%降至0.044%(χ^(2)=9.890,P=0.002)。结论 通过开展CRE医院感染流行病学特征研究可找出相应高危人群、高危科室等,建立多学科协作防控,可以实现CRE医院感染有效控制。

OBJECTIVE To understand the epidemiological characteristics of nosocomial infection caused by carbapenem-resistant Enterobacteriaceae(CRE) and evaluate the effect of intervention measures. METHODS From Jan 2014 to Dec 2020, the data were collected from the patients who were detected with CRE by using nosocomial infection surveillance system, the multi-disciplinary collaborative intervention mode of "infection control + clinical + medical technology" was established to curb the CRE infection. RESULTS A total of 634 228 hospitalized patients were monitored in 7 years, and 304 patients had CRE nosocomial infection, with the incidence rate 0.048%. The CRE infection showed a fluctuation in years and seasons. The incidence rate of CRE infection was higher in male patients than in female patients(χ^(2)=54.40,P<0.001), the incidence rate of CRE infection of the patients no less than 65 years old was 3.10 times as high as that of the patients less than 65 years old(χ^(2)=102.91,P<0.001). Among the patients with CRE infection, 59.54% had lower respiratory tract infection. Klebsiella pneumoniae was the predominant species of pathogen, accounting for 79.93%. The ICU patients were dominant, accounting for 50.66%. The incidence rate of CRE infection was decreased from 0.070% to 0.044% after intervention(χ^(2)=9.890,P=0.002). CONCLUSION The study of epidemiological characteristics of CRE nosocomial infection may help to find out the high risk population and high risk department and establish the multi-disciplinary collaborative intervention mode so as to effectively control of the CRE nosocomial infection.