外科重症监护室多重耐药菌主动筛查及定植危险因素  

Active screening and risk factors for colonization of multidrug-resistant organisms in a surgical intensive care unit

作　　者：张艳青[1] 郭燕艺[1] 甘明秀[1] 连双庆[1] 林璇[1] 

机构地区：[1]福建省立医院,福建福州350001

出　　处：《中国感染控制杂志》2014年第11期650-653,共4页Chinese Journal of Infection Control

基　　金：福建省卫生厅2011年厅青年科研课题(2011-1-1)

摘　　要：了解某院外科重症监护室（SICU）多重耐药菌（MDRO）的定植情况及其危险因素,为临床主动筛查MDRO提供依据。方法对2013年6月1日—8月31日入住该院SICU≥24 h的患者进行主动筛查,检测患者耐甲氧西林金黄色葡萄球菌（MRSA）、产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌（ESBL＋E.coli/Kp）定植情况,并进行相关危险因素分析。结果入住SICU≤48 h的患者MRSA及ESBL＋E.coli/Kp检出率分别为11.00%、73.00%;入住SICU〉7 d者MRSA及ESBL＋E.coli/Kp新增检出率分别达16.67%、44.44%。入住SICU前住院时间〉7 d[OR95%CI：4.48（1.21~16.65）]是患者入住SICU时检出MRSA的独立危险因素,APACHEⅡ评分≥16分[OR95%CI：6.36（1.47~27.54）]是患者入住SICU〉48 h检出MRSA的独立危险因素。结论入住SICU患者MDRO检出率高,随着住SICU时间的延长,MDRO的检出率不断上升。医院应开展主动筛查,及时发现MDRO定植患者,通过实施有效的隔离控制措施,降低医院感染发生。Objective To investigate colonization status and risk factors of multidrug-resistant organisms （MDROs） in a surgical intensive care unit （SICU）, and provide a basis for active clinical screening of MDROs. Methods From June 1,2013 to August 31,2013, patients who admitted to SICU≥24 hours were performed active screening, the colnization status of methicillin-resistant Staphylococcus aureus （MRSA） and extended-spectrum 13- lactamase-producing Escherichia coli/Klebsiella pneumoniae （ESBL-E. coli/Kp） among patients were detected, re- lated risk factors were analyzed. Results When patients who admitted to SICU≤48 hours, the detection rate of MRSA and ESBL-E. coli/Kp was 11.00 % and 73.00% respectively; when admitted to SICU 〉7 days, the increased detection rate of MRSA and ESBL-E. coli/Kp was 16.67% and 44.44% respectively. Patients stayed in hospital 〉7 days before admit- ting to SICU （0R95%CI：4. 48[1.21 - 16.65]） was an independent risk factor of carrying MRSA when admitting to SICU, APACHEⅡ score ≥16 （0R95%C：6. 36[1.47 - 27.54]） was an independent risk factor of carrying MRSA 48 hours after admitting to SICU. Conclusion When patients admitted to SICU, the carrying rate of MDROs is high, isola- tion rate rises with prolonged length of SICU stay. Hospitals should carry out MDRO colonization screening project among patients and implement effective isolation control measures to reduce the incidence of healthcare-associated infection.

关 键 词：外科重症监护室 多重耐药菌 定植 主动筛查 医院感染 

分 类 号：R181.32[医药卫生—流行病学]