非重症监护病房多重耐药菌感染来源及分布

Source and distribution of multidrug-resistant organisms infections in non-intensive care unit

目的:分析非重症监护病房(ICU)多重耐药菌(MDRO)感染来源及分布,为制定精准化MDRO防控措施提供依据。方法:选取南京医科大学第一附属医院2017年10月至2019年9月802例自非ICU科室MDRO感染者体内分离出的1116株MDRO菌株作为研究对象,依据来源将MDRO分为院外感染(外院转入、社区获得)和院内感染(本院转入、科室获得)两大类型共4个组别进行分析。结果:本院非ICU科室感染的MDRO以碳青霉烯类耐药肠杆菌科(CRE)(384/1116、34.41%)及耐甲氧西林金黄色葡萄球菌(MRSA)(331/1116、29.66%)为主;不同科室MDRO感染构成差异有统计学意义(χ^(2)=185.687、P<0.001),4种常见MDRO感染最多的科室为老年医学科(147/1116、13.17%)、神经外科(112/1116、10.04%)和康复医学科(95/1116、8.51%)。CRE、MRSA、碳青霉烯类耐药鲍曼不动杆菌(CRAB)和碳青霉烯类耐药铜绿假单胞菌(CRPA)检出率分别为10.69%(704/6584)、43.83%(554/1264)、33.72%(376/1115)和27.11%(475/1752),均显著低于全院科室CRE、MRSA、CRAB、CRPA的平均检出率[25.35%(3474/13704)、51.48%(1093/2123)、79.15%(4704/5943)和46.99%(2051/4365)],差异均有统计学意义(χ^(2)=584.309、15.583、960.632、203.726,P均<0.001);非ICU科室间以上4种MDRO检出率差异均有统计学意义(χ^(2)=190.766、97.642、75.078和69.515,P均<0.001)。MDRO感染部位主要为下呼吸道(540/1116、48.39%)、手术部位(132/1116、11.83%)和泌尿道(123/1116、11.02%)。院外感染者共641例(57.44%),包括外院转入(373/1116、33.42%)和社区获得(268/1116、24.01%);院内感染者475例(42.56%),包括本院转入(52/1116、4.66%)和科室获得(423/1116、37.90%)。结论:本院非ICU科室MDRO感染近2/3来源于院外输入和院内转入,需重视感染控制基本措施落实并通过信息系统早期识别,且各科室间MDRO感染来源及分布不同,应根据其特点制定针对性措施,实现精准化防控。

Objective To investigate the source and distribution of multidrug-resistant organisms(MDRO)infection in non-intensive care unit(ICU),and to provide basis for accurate prevention and control measures of MDRO.Methods Total of 1116 MDRO strains isolated from 802 patients with MDRO infection in the non-ICU departments of Jiangsu Provincial people’s Hospital from October 2017 to September 2019 were selected.According to the source,MDRO were divided into two types:out-of-hospital infection(transferred from outside hospital and community acquired)and nosocomial infection(transferred from our hospital and acquired from departments of our hospital).Results The main MDRO in non-ICU departments were carbapenem-resistant Enterobacteriaceae(CRE)(384/1116,34.41%)and methicillinresistant Staphylococcus aureus(MRSA)(331/1116,29.66%).There were significant differences in the composition of MDRO infection among different departments(χ^(2)=185.687,P<0.001).The departments with the most common MDRO infection were geriatrics(147/1116,13.17%),neurosurgery(112/1116,10.04%)and rehabilitation medicine(95/1116,8.51%).The detection rates of CRE,MRSA,carbapenemresistant Acinetobacter baumannii(CRAB)and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 10.69%(704/6584),43.83%(554/1264),33.72%(376/1115)and 27.11%(475/1752),respectively,which were significantly lower than those of departments from the whole hospital[25.35%(3474/13704),51.48%(1093/2123),79.15%(4704/5943)and 46.99%(2051/4365)],with significant differences(χ^(2)=584.309,15.583,960.632,203.726;all P<0.001).There were significant differences in the detection rates of the above four kinds of MDRO among different non-ICU departments(χ^(2)=190.766,97.642,75.078,69.515;all P<0.001).The most common sites of MDRO infection were lower respiratory tract(540/1116,48.39%),operation site(132/1116,11.83%)and urinary tract(123/1116,11.02%).There were 641 cases of out-of-hospital infection(57.44%),including out-of-hospital transfer(373/1116,33.42%)and community access(268/1116,24.01%);and 475 cases(42.56%)of nosocomial infection,including our hospital transfer(52/1116,4.66%)and department of our hospital access(423/1116,37.90%).Conclusions Nearly 2/3 of MDRO infections in non-ICU departments of our hospital are imported from outside of hospital and transferred in hospital.In addition,attention should be paid to the implementation of basic sensory control measures and early identification through the information system,and the sources and distribution of MDRO infections are different,so targeted prevention and control measures should be formulated according to their characteristics to achieve precise prevention and control.