重症监护室患者鼻腔金黄色葡萄球菌定植与医院感染的关系  

Nasal colonization of Staphylococcus aureus and nosocomial infection in intensive care unit

作　　者：李情操[1,2] 牧启田[1,3] 常燕子[2] 卢雯君[2] 

机构地区：[1]宁波大学医学院,浙江宁波315211 [2]宁波市医疗中心李惠利医院,浙江宁波315040 [3]宁波市第一人民医院,浙江宁波315040

出　　处：《上海预防医学》2015年第10期617-620,共4页Shanghai Journal of Preventive Medicine

基　　金：宁波市科技计划项目(2012A610189)

摘　　要：目的分析重症监护室(ICU)患者鼻腔定植金黄色葡萄球菌(SA)与院内感染的关系和安尔碘III鼻腔去定植治疗效果。方法对入院患者行鼻拭子细菌学检测,并观察所有患者医院感染的发生情况。将有SA定植者分为对照组和治疗组,对照组给予常规治疗和护理,治疗组在此基础上再给予安尔碘III鼻腔去定植治疗。观察两组患者鼻腔SA清除率和医院感染的发生情况。结果共751例患者入选本研究,108例发生医院感染,发生率为14.38%。SA鼻腔定植85例(11.3%),其中耐甲氧西林金黄色葡萄球菌(MRSA)定植者33例(4.4%),MRSA定植患者入院后医院感染发生率为51.5%,明显高于其他类型细菌定植者(P<0.05)。治疗组鼻腔SA清除率为81.4%,明显高于对照组的42.8%(P<0.05);治疗组医院感染发生率为16.3%,明显低于对照组的40.5%(P<0.05);MRSA定植患者经去定植治疗以后,医院感染发生率为25.0%,明显低于对照组的76.5%(P<0.05)。结论 ICU患者中鼻腔MRSA定植者医院感染发生率明显增高,安尔碘III去定植治疗可以提高鼻腔SA清除率,降低医院感染的发生率。Objective To investigate the relationship between nasal colonization of Staphylococcus aureus（SA） and nosocomial infection in intensive care unit（ICU）, and observe the therapeutic effect of Anerdian III in nasal decolonizaion. Methods Bacterial cultures were made by means of nasal swabs among inpatients whom the occurrence of nosocomial infection were observed.Patients with SA colonization were randomly divided into two groups：control and treatment.Control group were given regular treatment, and treatment group were administered Anerdian III in addition to regular treatment.Then the clearance rate of SA and the occurrence of nosocomial infection of two groups were observed. Results A total of 751 patients were enrolled, of whom 108（14.4%） were with nosocomial infection and 85（11.3%） with SA nasal colonization. Methicillin resistant Staphylococcus aureus （ MRSA ） was detected in 33 patients （4.4%）.The nosocomial infection rate of patients with MRSA colonization was 51.5%, which was significantly higher than those in patients with other bacterial colonization（P〈0.05）.The SA clearance rate in treatment group was significantly higher than that in control group（81.4% vs.42.8%,P〈0.05）.The nosocomial infection rate in treatment group was significantly lower than that in control group （ 16 .3% vs. 40.5%,P 〈0.05）.After decolonization treatment,the nosocomial infection rate of patients with MRSA colonization was significantly lower than that in control group（25.0% vs.76.5%,P 〈0.05）. Conclusion The incidence rate of nosocomial infection in patients with MRSA nasal colonization is markedly increased in ICU, and the decolonization treatment by Anerdian III increases the clearance rate of nasal SA and decreases the incidence rate of nosocomial infection.

关 键 词：重症监护室 金黄色葡萄球菌 定植 医院感染 安尔碘 消毒 

分 类 号：R446.5[医药卫生—诊断学]