多重耐药定植菌与医院感染的关系及去定植措施的效果研究  

Relationship between multi-drugresistant colonization and nosocomial infections and the effect of transplanting measures

作　　者：郭立华[1] 沈秀丽 刘锋[1] GUO Li-hua;SHEN Xiu-li;LIU Feng(China-Japan Friendship Hospital of Jilin University,Changchun,Jilin 130031,China)

机构地区：[1]吉林大学中日联谊医院肾内科透析室,吉林长春130031 [2]吉林大学中日联谊医院口腔科,吉林长春130031

出　　处：《中华医院感染学杂志》2018年第15期2249-2252,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81000108)

摘　　要：目的分析多重耐药定植菌与医院感染的相关性,并评估去定植措施的临床效果。方法选取2016年1月-2017年9月医院收治的重症患者186例为研究对象,分别采集所有患者的鼻拭子与肛拭子标本进行多重耐药菌定植检测,观察其多重耐药菌分布情况,并统计本组患者医院感染发生率。随机将88例定植患者分为对照组与试验组各44例,对照组患者均根据临床经验进行常规救治与隔离处置,试验组患者中存在多重耐药菌感染者在常规救治基础上给予去定植措施,比较两组患者的医院感染发生率。结果 186例患者中发生多重耐药菌定植88例,定植率为47.3%,其中包括入院时定植68株占77.3%、医院获得性定植20株占22.7%;多重耐药菌分布以产β-内酰胺酶细菌70株为主,其次为耐甲氧西林金黄色葡萄球菌9株、多重耐药鲍氏不动杆菌8株;发生多重耐药菌定植患者的医院感染发生率为23.9%(21/88),高于未发生多重耐药菌定植患者的医院感染发生率11.2%(11/98)(χ2=5.200,P=0.023);试验组患者的医院感染发生率为6.8%(3/44),低于未行去定植措施的对照组患者的27.3%(χ2=6.510,P=0.011);试验组患者经去定植处理后的多重耐药菌定植14例少于对照组患者的38例(χ2=7.138,P=0.003)。结论多重耐药菌定植主要以产β-内酰胺酶细菌为主,发生定植患者存在较高的医院感染风险,通过对危重患者开展多重耐药菌早期筛查,及时明确定植情况并给予合理的去定植措施有助于全面避免医院感染的发生,从而提高患者临床治疗成功率与安全性。OBJECTIVE To analyze the relationship between multi-drugresistant colonization and nosocomial infection,and to evaluate the clinical effect of the transplanting measures.METHODS A total of 186 severe patients treated from Jan.2016 to Sep.2017 were selected.Nasal swabs and anal swabs samples from all patients were collected for multidrug-resistant bacterial colonization.The distribution of multidrug-resistant bacteria was observed,and the incidence of nosocomial infections was counted.A total of 88 patients of colonization were randomly divided into control group and observation group,with 44 cases in each group.The patients in control group were given routine treatment and isolation treatment according to clinical experience.The patients in the observation group with multi-drugresistant bacteria infection were given transplanting measures based on the control group.The incidence of nosocomial infections in the two groups was compared.RESULTS There were 88 cases of multi-drugresistant bacteria colonization in 186 patients,and the colonization rate was 47.3%.At the time of admission,68（77.3%）were colonized,and 20（22.7%）were hospital acquired colonization.The multi-drugresistant bacteria distributed mainly in 70 strains of beta-lactamase producing bacteria,followed by 9 strains of methicillin-resistant Staphylococcus aureus and 8 strains of multidrug-resistant Acinetobacter baumannii.The incidence of nosocomial infections in patients with multi-drugresistant bacteria colonization was 23.9%（21/88）,which was significantly higher than that in patients without multi-drugresistant bacteria colonization of 11.2%（11/98）（χ^2=5.200,P=0.023）.The incidence of nosocomial infections in the observation group was 6.8%（3/44）,which was significantly lower than 27.3%in the control group（χ^2=6.510,P=0.011）.The colonization of multi-drugresistant bacteria in the observation group was 14 cases（31.3=8%）,which was less than 38 cases in the control group（χ^2=7.138,P=0.003）.CONCLUSION Colonization of m

关 键 词：多重耐药定植菌 医院感染 去定植措施 

分 类 号：R181.3[医药卫生—流行病学]