重症监护病区CRE主动筛查及其效果评价  

Active screening of CRE in intensive care unit and its effect

作　　者：陈美恋 王守军[1] 匡季秋[1] 刘荣[1] 李冬梅[1] 郝云霄[1] 曹煜隆 高燕[1] 

机构地区：[1]北京大学人民医院医院感染管理办公室,北京100044

出　　处：《中华医院感染学杂志》2017年第18期4123-4126,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81541139)

摘　　要：目的评价耐碳青霉烯类肠杆菌科细菌(CRE)主动筛查结合加强干预在重症监护病区(ICU)医院感染预防控制中的效果,为CRE医院感染预防与控制提供科学依据。方法以2016年6月1日-2017年4月30日入住ICU的患者为干预组,患者转入/入院时进行CRE主动筛查,选取2016年1月1日-2016年5月31日未开展CRE主动筛查的ICU住院患者作为对照组,对照组由临床医师根据患者病情进行细菌培养;两组患者均进行医院感染实时监测,CRE培养阳性者均采取接触隔离措施;采用χ~2检验比较主动筛查前后CRE医院感染率的变化。结果共监测2327例ICU住院患者(其中干预组1596例,对照组731例),干预期间CRE主动筛查率为68.23%(1089/1596),患者主动筛查CRE的定植率为4.22%(46/1089);以直肠的CRE定植率10.90%(41/376)最高,病原体以耐碳青霉烯类肺炎克雷伯菌(CRKP)最多,占84.78%(39/46);研究期间CRE医院感染率为0.99%(23/2327),医院感染病原体以CRKP为主,占86.96%(20/23);采取主动筛查干预措施后,干预组的CRE医院感染率(0.69%)显著低于对照组的CRE医院感染率1.64%。结论 CRE定植以CRKP为主,直肠中CRE定植率较高,采取主动筛查能够有效控制重症监护病区CRE医院感染的发生。OBJECTIVE To evaluate the effect of active screening of carbapenem-resistant Enterobacteriaceae（CRE）combined with intensive intervention on prevention of nosocomial infections in intensive care unit（ICU）so as to provide scientific basis for prevention and control of CRE nosocomial infections.METHODS The patients who were hospitalized the ICU from Jun 1,2016 to Apr 30,2017 were chosen as the intervention group,the active screening of CRE was carried out for the patients when they were transferred or admitted;the patients who were hospitalized the ICU from Jan 1,2016 to May 31,2016 and did not receive the active screening of CRE were assigned as the control group.The bacterial culture was conducted for the patients in the control group by clinicians based on the illness condition.The real-time surveillance of nosocomial infections was carried out for the two groups of patients,and the contact isolation measures were taken for the patients with positive CRE culture.The change of incidence of CRE nosocomial infections was compared by means of chi-square test before and after the active screening.RESULTS A total of 2327 hospitalized ICU patients were monitored,including 1596 patients in the intervention group and 731 patients in the control group.The rate of active screening of CRE was 68.23% （1089/1596）during the intervention period,the colonization rate of active screening of CRE was 4.22% （46/1089）;the colonization rate of rectal CRE was the highest（10.90% ,41/376）.Carbapenem-resistant Klebsiella pneumoniae strains were dominant among the pathogens,accounting for 84.78% （39/46）.The incidence of CRE nosocomial infections was 0.99% （23/2327）during the stud period,CRKP strains were dominant among the pathogens causing nosocomial infections,accounting for 86.96% （20/23）.The incidence of CRE nosocomial infection was 0.69% in the intervention group after the active screening interventions were taken,significantly lower than 1.64% in the control group.CONCLUSION The CRKP strains are dominan

关 键 词：主动筛查 耐碳青霉烯类肠杆菌科细菌 效果评价 重症监护病区 

分 类 号：R378[医药卫生—病原生物学]