重症医学科耐碳青霉烯类革兰阴性杆菌环境定植调查分析

Investigation and Analysis of Environmental Colonization of Carbapenem-resistant Gram-negative Bacilli in Intensive Care Unit

目的通过对重症医学科(ICU)耐碳青霉烯类革兰阴性杆菌(CRO)环境定植调查分析研究来寻找CRO感染的高风险因素,以点带面为降低ICU多重耐药菌院内发病密度提供方案。方法选择成都市新都区人民医院综合ICU工作人员高频接触点开展环境表面微生物分布调查,与临床实际检出CRO株耐药谱进行分析比对,寻找ICU是否存在患者与环境之间CRO交叉传播现象。2020年1—6月为干预前期,2020年7—12月为干预后期,收集分离并鉴定目标菌株,分析ICU CRO感染风险点并采取相应干预措施,对比干预前后CRO环境检出率及ICU多重耐药菌院内发病密度、手卫生依从性、多重耐药菌感染发现率、ICU感染发现率。结果2020年1—12月共采集标本588份,其中干预前期采集304份样本,分离出39株CRO菌株,检出率为12.83%,以耐碳青霉烯类鲍曼不动杆菌(CRAb)、耐药碳青霉烯类肠杆菌(CRE)检出较多;干预后期采集284份样本,分离出7株CRO菌株,检出率为2.46%,仍以CRAb、CRE检出较多。干预前后CRO环境检出率差异有统计学意义(P<0.001),ICU多重耐药菌院内发病密度从11.18‰降至5.41‰(P=0.003),ICU多重耐药菌感染发现率从5.31%降至1.56%(P=0.012),ICU感染发现率从5.98%降至2.47%(P=0.002),手卫生依从性从74.55%升至92.45%(P<0.001)。结论通过对ICU中CRO环境定植调查分析,发现CRO存在人与环境交叉传播现象,寻找交叉传播具体途径,采取针对性干预措施,可降低ICU多重耐药菌院内发病密度。

Objective To investigate and analyze the environmental colonization of carbapenem-resistant gram-negative bacilli(CRO)in intensive care unit(ICU),so as to find out high risk factors for CRO infection,and to provide targeted interventions to reduce nosocomial incidence density of multidrug-resistant bacteria in ICU.Methods The high-frequency contact sites of comprehensive ICU staff in Xindu District People's Hospital of Chengdu were selected for the investigation on the distribution of microorganisms on environmental surfaces.The drug resistance spectrum of strains found were analyzed and compared with that of CRO strains detected in clinical practice,so as to find out whether there was cross-transmission of CRO between the patients and the environment in the ICU.In the pre-intervention period(from January to June 2020)and the post-intervention period(from July to December 2020),the target strains were collected,isolated and identified.The risk sites of CRO infection in the ICU were analyzed,and corresponding interventions were taken.The environmental detection rate of CRO,the nosocomial incidence density of multidrug-resistant bacteria in ICU,the compliance of hand hygiene,the detection rate of multidrug-resistant bacteria infection,and the nosocomial infection rate were compared before and after intervention.Results A total of 588 samples were collected from January to December 2020.In the pre-interven-tion period,304 samples were collected from which 39 CRO strains were isolated,with a detection rate of 12.83%,mostly carbapenem-resistant Acinetobacter baumannii(CRAb)and carbapenem-resistant Enterobacter(CRE).In the post-intervention period,284 samples were collected from which 7 CRO strains were isolated,with a detection rate of 2.46%,and CRAb and CRE were still the main strains.There was a statistically significant difference in the environmental detection rate of CRO before and after intervention(P<0.001).The nosocomial incidence density of multidrug-resistant bacteria in ICU decreased from 11.18‰to 5.41‰(P=0.003).The detection rate of multidrug-resistant bacteria infection in ICU decreased from 5.31%to 1.56%(P=0.012).The detection rate of ICU infection decreased from 5.98%to 2.47%(P=0.002).And the compliance of hand hygiene increased from 74.55%to 92.45%(P<0.001).Conclusion Through the investigation and analysis of environmental colonization of CRO in ICU,it is found that there is cross-transmission of CRO between patients and the environment.The nosocomial incidence density of multidrug-resistant bacteria in ICU is reduced by finding specific ways of cross-transmission and taking targeted interventions.