集束化管理在儿童多重耐药大肠埃希菌感染防控中的应用  

Application of bundle management in the prevention and control of multidrug-resistant Escherichia coli infection in children

作　　者：邱小梅[1] 陈昂[1] 谢广清[1] 刘莉 赵芳[1] 邹剑成[1] QIU Xiao-mei;CHEN Ang;XIE Guang-qing;LIU Li;ZHAO Fang;ZOU Jian-cheng(Department of Healthcare-associated Infection Management,Boai Hospital,Zhongshan 528400,China)

机构地区：[1]中山市博爱医院医院感染管理科,广东中山528400

出　　处：《中国感染控制杂志》2021年第2期180-185,共6页Chinese Journal of Infection Control

基　　金：广东省中山市科技局基金项目(2014A1FC143)。

摘　　要：目的分析0~14岁儿童多重耐药大肠埃希菌感染的危险因素,探讨集束化管理在其感染防控中的应用价值。方法以某院2016年6月1日—2019年9月30日收治的感染患者为研究对象。2016年6月1日—2017年12月31日为观察组,2018年1月1日—2019年9月30日为集束化管理组。分析观察组患者临床资料,探讨患者发生多重耐药大肠埃希菌感染的危险因素,并根据结果调整集束化管理方案,比较两组患者多重耐药大肠埃希菌感染情况。结果共调查观察组343例患者,集束化管理组328例患者。观察组中有70例多重耐药大肠埃希菌感染患者,非ICU住院时间≥14 d、ICU住院时间≥7 d、呼吸道感染、机械通气、机械通气≥7 d、联合应用抗菌药物、抗菌药物使用时间≥14 d均为观察组患者多重耐药大肠埃希菌感染的独立危险因素(均P<0.05)。集束化管理组患者手卫生依从率(95.99%)高于观察组(94.39%),多重耐药大肠埃希菌感染在感染病例中所占比率(14.02%)低于观察组(20.41%),差异均有统计学意义(均P<0.05)。集束化管理组患者机械通气时间、中心静脉置管时间、抗菌药物使用时间、住院时间及住院费用均低于观察组,差异均有统计学意义(均P<0.05)。结论儿童多重耐药大肠埃希菌感染受多种因素影响,应用集束化管理可减少其感染情况的发生。Objective To analyze the risk factors for multidrug-resistant Escherichia coli(MDR-EC)infection in children aged 0-14 years,and explore the application value of bundle management in the prevention and control of infection.Methods Patients with infection in a hospital from June 1,2016 to September 30,2019 were selected as the research objects.The observation group was from June 1,2016 to December 31,2017,bundle management group was from January 1,2018 to September 30,2019.Clinical data of patients in observation group were analyzed,risk factors for MDR-EC infection were explored,bundle management scheme was adjusted according to the results,MDR-EC infection between two groups of patients was compared.Results A total of 343 patients in observation group and 328 patients in bundle management group were investigated.In observation group,70 patients were with MDR-EC infection,the independent risk factors for MDR-EC infection in patients in observation group were non-ICU hospitalization time≥14 days,ICU hospitalization time≥7 days,respiratory tract infection,mecha-nical ventilation,mechanical ventilation≥7 days,combined use of antimicrobial agents,and antimicrobial use time≥14 days(all P<0.05).Compliance rate of hand hygiene in patients in bundle management group was higher than that in observation group(95.99%vs 94.39%).The proportion of MDR-EC infection in infection cases was lower than that in observation group(14.02%vs 20.41%),differences were both significant(both P<0.05).The mechanical ventilation time,central venous catheterization time,antimicrobial use time,hospitalization time and hospitalization expenses of bundle management group were all lower than those of observation group,differences were all statistically significant(all P<0.05).Conclusion MDR-EC infection in children is affected by many factors,bundle management can reduce the occurrence of infection.

关 键 词：集束化管理 多重耐药大肠埃希菌 儿童 影响因素 

分 类 号：R181.3[医药卫生—流行病学]