从ICU病房MRSA和CRAB的连续5年监测数据看不同多重耐药菌应有不同的防控策略  

Monitoring data of 5 continuous years of MRSA and CRAB in ICU support different prevention and control strategies against different MDROs

作　　者：卢岩[1] 张秀月[1] 张智洁[2] 周秀珍[2] 贾嘉[3] 于晓江[3] 彭松林[4] 安春丽[5] 

机构地区：[1]中国医科大学附属盛京医院感染管理办公室,辽宁沈阳110004 [2]中国医科大学附属盛京医院检验科,辽宁沈阳110004 [3]中国医科大学附属盛京医院ICU病房,辽宁沈阳110004 [4]中国医科大学附属盛京医院肝胆脾外科,辽宁沈阳110004 [5]中国医科大学病原生物学教研室,辽宁沈阳110001

出　　处：《中国微生态学杂志》2015年第10期1163-1166,1173,共5页Chinese Journal of Microecology

基　　金：中华医学基金会项目(09-997);国家自然科学基金(81370189);沈阳市科学技术项目(F13-221-9-24);盛京医院院内课题基金(MB92)

摘　　要：目的通过观察不同防控措施对不同多重耐药菌的防控效果,探讨和确定适合不同多重耐药菌的防控策略。方法采用每月新发的感染/定植菌检出密度的计算方法,对2008年1月至2012年12月ICU病房重要的耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类抗生素的鲍曼不动杆菌(CRAB)两种多重耐药菌进行实时的动态追踪监测,对在监测过程中采用的手卫生、环境清洁消毒和严格接触隔离等防控措施进行了时间上的追踪比对。结果实施手卫生防控措施辅以环境清洁消毒后MRSA的感染/定植密度迅速减少并保持低水平检出密度;而在手卫生和环境清洁消毒措施基础上,增加了严格的接触隔离结合加强感染/定植上呼吸机患者气道管理后CRAB检出密度才逐步降低。结论针对不同的多重耐药菌应有不同的防控策略。手卫生对MRSA的防控效果好于对CRAB,防控CRAB需要多个措施综合防控。Objective To investigate and determine the appropriate preventing and controlling strategies for different multidrug-resistant organisms by observeing the effect of different control measures. Methods The infection and density of colonization of bacteria per thousand clays was calculated; dynamic monitoring was conducted on the major methicillin-resistant Staphylococcus aureus （MRSA） and carbapenem-resistant Acin- etobacter bauman CRAB） from January 2008 to December 2012 in ICU; At the same time, the prevention and control measures including hand hygiene, environmental cleaning and disinfection, and regional isolation etc. were tracked and compared on a time basis. Results Upon implementation of hand hygiene supplemen- ted with environmental cleaning and disinfection, the infection and colonization density of MRSA reduced rapidly and remained at a low detection level. While the infection and colonization density of CRAB was gradually reduced until strict isolation combined with respiratory control on the basis of the hand hygiene andenvironmental cleaning and disinfection were carried out. Conclusion Different control strategies should be implemented for different multiple drug-resistant organisms. Hand hygiene supplemented with environmen- tal cleaning and disinfection measures is effective for MRSA control, while the prevention and control of CRAB requires comprehensive measures especially strict isolation combined with respiratory control.

关 键 词：多重耐药 MRSA CRAB 医院感染 防控策略 

分 类 号：R184[医药卫生—流行病学]