ICU耐碳青霉烯类革兰阴性菌感染患者头发定植状况及其去定植方法

Carbapenem-resistant gram-negative bacteria colonized in hair of ICU patients and decolonization effect

目的分析重症监护室(ICU)耐碳青霉烯鲍氏不动杆菌(CRAB)、耐碳青霉烯肺炎克雷伯菌(CRKP)感染患者头发定植情况,探讨不同洗发方式去定植效果。方法选择2022年3月—2023年3月北京某三甲教学综合医院ICU符合纳入标准的CRAB、CRKP感染患者,洗发方式分别采用常规洗发水(对照组)、2%氯己定溶液(干预1组)和2%氯己定洗发帽(干预2组)去定植,比较3种洗发方式的洗发时间及洗发后不同时间头发CRAB、CRKP的检出率及平均菌落计数。结果共105例患者符合纳入标准,洗发后不同时间共采集头发进行细菌培养345例次,对照组中CRAB、CRKP总检出率为42.86%(36/84)高于干预1组22.40%(28/125)和干预2组12.50%(17/136)(P<0.05),但两个干预组比较无统计学差异;三组患者头发总菌量和革兰阴性菌量比较差异有统计学意义(P<0.05);对照组头发CRAB的检出率(45.31%)约为CRKP(11.47%)的4倍(c~2=15.828,P<0.001);两个干预组洗发后1 d和3 d均可以有效去定植(P<0.05),但干预2组洗发后1 d去定植效果优于洗发后3 d(P<0.05);3种洗发方式洗发时间比较有统计学差异(P<0.05),洗发时间最短的是干预2组。结论CRAB、C RKP感染患者头发检出阳性率较高,且CRAB的检出率高于CRKP,采用2%醋酸氯己定溶液和2%葡萄糖氯己定洗发帽均可有效降低头发CRAB和CRKP检出率,洗发帽可以节约护理人力,节省操作时间,护理满意度高,可在临床进行推广。

OBJECTIVE To investigate the status of colonization of carbapenem-resistant Acinetobacter baumannii(CRAB)and carbapenem-resistant Klebsiella pneumoniae(CRKP)in hair of intensive care unit(ICU)patients and observe the decolonization effects of different hair washing methods.METHODS From Mar 2022 to Mar 2023,the ICU patients of a three-A teaching general hospital who had CRAB and CRKP infection and met the inclusion criteria were enrolled in the study.The patients were treated with different hair washing methods for decoloniza-tion,the control group was treated with conventional washing shampoo,the intervention 1 group was treated with 2%chlorhexidine solution,and the intervention 2 group was treated with 2%chlorhexidine hair washing cap.The hair washing time,isolation rates of CRAB and CRKP,and average bacterial colony counts were observed and comparted among the three groups.RESULTS A total of 105 patients met the inclusion criteria,and totally 345 case-times of bacterial culture were carried out for the hair specimens that were collected from the patients after the hair washing for different time periods.The total isolation rate of CRAB and CRKP of the control group was 42.86%(36/84),higher than 22.40%(28/125)of the intervention 1 group and 12.50%(17/136)of the interven-tion 2 group(P<0.05),there was no significant difference between the two intervention groups;there were sig-nificant differences in the total bacterial colony counts of hair and the colony counts of gram-negative bacteria a-mong the three groups of patients(P<0.05).The isolation rate of CRAB(45.31%)of the control group was 4 times the isolation rate of CRKP(11.47%)(c2=15.828,P<0.001).The hair washing methods of the two inter-vention groups could achieve remarkable effects on decolonization after hair washing for 1 and 3 days(P<0.05);however,the hair washing method of the intervention 2 group could achieve more remarkable effect after the hair washing for 1 day than after the hair washing for 3 days(P<0.05);there was significant difference in the hair washing time among the three hair washing methods(P<0.05),and the hair washing time of the intervention 2 group was the shortest.CONCLUSION The positive rates of isolation of CRAB and CRKP from hair are high a-mong the patients,and the isolation rate of CRAB is higher than that of the CRKP.Both 2%chlorhexidine acetate solution and 2%chlorhexidine glucose cap can effectively reduce the isolation rates of CRAB and CRKP.The hair washing cap may help to save nursing work force,shorten the operation time and raise the satisfaction with nurs-ing.It is worthy to be promoted in the hospital.