主动筛查降低PICU中产超广谱β-内酰胺酶的效果评估研究  

Effect of active screening on reduction of infections caused by extended-spectrum β-lactamase producing bacteria in pediatric ICU

作　　者：乔甫[1] 李诗雨[1] 唐梦玲[2] 尹维佳[1] 庄红娣[1] 王妍潼[1] 朱仕超[1] 黄文治[1] 宗志勇[1] 

机构地区：[1]四川大学华西医院感染管理科,四川成都610041 [2]四川大学华西医院儿科ICU,四川成都610041

出　　处：《中华医院感染学杂志》2014年第10期2546-2548,共3页Chinese Journal of Nosocomiology

基　　金：四川省科技厅基金资助项目(2008FG0004)

摘　　要：目的了解儿科重症监护病房(PICU)患儿中产超广谱β-内酰胺酶大肠埃希菌(ESBLs-ECO)和肺炎克雷伯菌(ESBLs-KPN)的定植情况,评价主动筛查结合接触隔离措施降低其感染的效果。方法队列研究,从2010年1月-2011年2月为第1阶段,采集ESBLs-ECO和ESBLs-KPN医院感染的基线数据;2011年3-8月为第2阶段,主动筛查ESBLs-ECO和ESBLs-KPN,报告结果但未采取接触隔离措施;2011年9-12月为第3阶段,洗脱期;2012年1-12月为第4阶段,主动筛查,对定植和感染病例均采取接触隔离措施。结果共纳入4 031例患者,入PICU时ESBLs-ECO和ESBLs-KPN的定植率分别为45.29%、7.34%;各研究阶段ESBLs-ECO的医院感染率分别为0.46%、0.38%、0.57%、0.55%,无下降趋势;各阶段ESBLs-KPN的医院感染率分别为0.92%、0.76%、0.57%、0.49%,虽呈下降趋势,但差异无统计学意义;与未定植的患者相比,定植了ESBLsECO和ESBLs-KPN的患者更易获得相应细菌的医院感染(P<0.05)。结论 PICU中ESBLs-ECO和ESBLsKPN的定植情况非常严重,定植者更易获得相关细菌的医院感染,采取主动筛查或主动筛查结合接触隔离的措施降低ESBLs-ECO和ESBLs-KPN医院感染的效果需要进一步评估。OBJECTIVE To understand the status of colonization of extended-spectrum β-lactamase（ESBLs）-produ- cing Escherichia coli and Klebsiella pneumoniae in the patients of pediatric intensive care unit （PICU） and evalu- ate the effect of active screening combined with contacting isolation measures on reduction of incidence of infec- tions. METHODS A four-stage cohort study was conducted, the phase 1 was from Jan 2010 to Feb 2011, the base- line data of the cases of nosocomial infections caused by ESBLs-producing E. coli and K. pneumoniae were collect- ed; the phase 2 was from Mar 2011 to Aug 2011, the active screening of ESBLs-producing E. coli and K. pneu- moniae was performed, the result was reported, but the contacting isolation measures were not adopted; the phase 3 was from Sep 2011 to Dec 2011, and it was the washout period; the phase 4 was from Jan 2012 to Dec 2012, the active screening was performed, and the contacting isolation measures were taken by all the cases of colonization or infections. RESULTS A total of 4 031 patients were included, the colonization rates of the ESBLs-producing E. coli and K. pneumoniae were respectively 45.59 % and 7.34 % at the admission to PICU. The incidence rate of ESBLs- producing E. coli infection was 0.46% in phase 1, 0.38% in phase 2, 0.57% in phase 3, 0.55% in phase 4, and the incidence rate did not show an downward trend. The incidence rate of ESBLs-producing K. pneurnoniae infec- tion was 0.92% in phase 1, 0.76% in phase 2, 0.57% in phase 3, 0.49% in phase 4, although the incidence rate showed an downward trend, the difference was not significant. As compared with the patients without the eoloni-zation, the patients with the colonization of ESBLs-produeing E. coli or K. pneumoniae were prone to be infected by the bacteria. CONCLUSION The colonization of ESBLs-producing E. coli or K. pneumoniae is very severe in the PICU, the patients with colonization are prone to be infected by the bacteria. The effect of the active screening or the active screening combined with

关 键 词：主动筛查 产超广谱Β-内酰胺酶 医院感染 定植 接触隔离 

分 类 号：R181.32[医药卫生—流行病学]