ICU患者多药耐药菌医院感染特点与集束化干预措施防控效果研究  

Clinical characteristics of ICU multidrug-resistant bacteria nosocomial infection prevention and control effects of cluster intervention

作　　者：房君[1] 王春英[1] 陈瑜[1] 虞立[1] 邢红叶 

机构地区：[1]宁波市第二医院护理部,浙江宁波315000

出　　处：《中华医院感染学杂志》2018年第4期522-526,共5页Chinese Journal of Nosocomiology

基　　金：浙江省卫计委医药卫生科技基金资助项目(2016A610154)

摘　　要：目的了解ICU患者多药耐药菌医院感染的特点和集束化干预措施的效果。方法选择2014年12月-2016年1月于医院ICU治疗的患者1460例,分为干预组和对照组,各730例。分析感染患者病原菌特点和药敏情况,对照组患者的ICU病房一般常规护理干预,干预组患者在对照组基础上给予相关集束化干预措施,观察两组患者的住院天数和病情转归情况。结果 1460例在医院ICU治疗的患者共发生感染221例,感染率为15.14%,其中干预组57例少于对照组164例(P<0.05);发生例次感染246例,例次感染率为16.85%,其中干预组感染89例次少于对照组157例次(P<0.05);多药耐药菌感染67例,多药耐药感染率4.59%,感染部位以下呼吸道为主;246例次ICU患者的标本中共检测出病原菌498株,其中革兰阴性菌369株占74.10%,革兰阳性菌108株占21.69%,真菌21株占4.22%;革兰阴性菌对目前临床常用抗菌药物均存在一定的耐药性,其中鲍氏不动杆菌对氨苄西林、头孢曲松、头孢唑林及呋喃妥因的耐药率为100.00%,肺炎克雷伯菌对氨苄西林的耐药率为100.00%,铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦及大肠埃希菌对氨苄西林、头孢曲松和头孢唑林的耐药率为100.00%;金黄色葡萄球菌对青霉素G、红霉素和氨苄西林/舒巴坦及表皮葡萄球菌对青霉素G的耐药也高达100.00%,主要革兰阳性菌对呋喃妥因和万古霉素等较敏感;干预组住院天数为(32.34±5.70)d少于对照组(57.82±9.80)d(P<0.05);干预组患者在治疗的转归情况优于对照组(P<0.05)。结论对于ICU患者多药耐药医院感染的情况,临床须加强耐药菌株的监测和相关耐药基因的研究,采取合理的有效的集束化干预措施和敏感抗菌药物治疗,降低耐药菌株的产生和避免其在医院流行和传播。OBJECTIVE To understand the clinical characteristics of ICU multidrug-resistant bacteria nosocomial infection and the effects of cluster intervention on its prevention and control.METHODS A total of 1460 patients treated in ICU from Dec.2014 to Jan.2016 were selected,and were randomly divided into intervention group and control group,with 730 cases in each group.The distribution characteristics and drug susceptibility of the pathogens were analyzed.Patients in control group were treated with the general routine nursing intervention of the ICU ward,and patients in intervention group were given the relevant cluster intervention measures on the basis of control group.The days of hospitalization and prognosis of the two groups of patients were observed.RESULTS Among the 1460 patients who were treated in the ICU,221 cases were infected,and the infection rate was 15.14%.There were 57 cases in intervention group,which was less than 164 cases in control group（P〈0.05）.There were246 cases of infections,and the infection rate was 16.85%.In 246 cases of infections,87 cases were infected in intervention group,which was less than 157 cases in control group（P〈0.05）.Among them,67 cases were multi drug resistant and multidrug-resistant rate was 4.59%.The main infection site was respiratory tract.Totally 498 pathogens were detected in 246 cases of ICU samples,including 369 strains of gram-negative bacteria accounting for 74.10%,108 strains of gram-positive bacteria accounting for 21.69% and 21 strains of fungi accounting for 4.22%.Gram-negative bacteria had some resistance to the commonly used antibiotics in clinical practice,of which the resistant rates of Acinetobacter baumannii to ampicillin,ceftriaxone,cefazolin and nitrofurantoin were 100%,the resistant rate of Klebsiella pneumoniae to ampicillin was 100%,the resistant rates of Pseudomonas aeruginosa to ampicillin and ampicillin/sulbactam and Escherichia coli to ampicillin,ceftriaxone and cefazolin were 100.00%,and the resistant rates of Staphylococcus aureus to p

关 键 词：ICU患者 多药耐药病原菌 医院感染 临床特点 集束化 干预措施 

分 类 号：R378[医药卫生—病原生物学]