儿童重症监护病房耐碳青霉烯类肠杆菌科细菌主动筛查及临床资料分析  

Active screening and clinical data of carbapenem-resistant Enterobacteriaceae in pediatric intensive care unit

作　　者：管红艳 刘婧娴[1] 陈峰[1] 刘瑛[1] GUAN Hongyan;LIU Jingxian;CHEN Feng;LIU Ying(Department of Laboratory Medicine,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院检验科微生物室,上海200092

出　　处：《中国感染与化疗杂志》2021年第4期444-448,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨耐碳青霉烯类肠杆菌科细菌(CRE)主动筛查方法学差异,分析上海交通大学医学院附属新华医院儿童重症监护病房(PICU)CRE定植患者的临床资料。方法收集2019年5—10月入住PICU患者的咽拭子及肛拭子,使用纸片筛选自建法和肉汤增菌法筛查CRE,比较两种方法学的筛查结果。查阅CRE筛查阳性患者病史并进行临床环境采样,对CRE筛查阳性的患者,及时采取干预措施。使用WHONET 5.6软件统计CRE主动筛查前后PICU科室CRE感染率情况,收集并分析CRE筛查阳性患者的临床资料。结果肉汤增菌法检测CRE的阳性率比纸片筛选自建法高5.4%,检出的CRE菌株以耐碳青霉烯类肺炎克雷伯菌(CRKP)为主,占86.0%。PICU科室自开展CRE主动筛查并采取干预措施后,CRE的感染率呈逐渐下降趋势。CRE筛查阳性患者中,70.0%(21/30)患者有广谱抗菌药物使用史,大部分患者有消化道及呼吸道手术病史,术后出现不同部位CRE感染。结论肉汤增菌法可以显著提高CRE的检出率。开展CRE主动筛查并尽早实施干预措施,有利于减少临床CRE感染。Objective To evaluate different methods for actively screening carbapenem-resistant Enterobacteriaceae(CRE),and analyze the clinical data of the patients positive for CRE screening in pediatric intensive care unit(PICU)in Xinhua Hospital,Shanghai Jiaotong University School of Medicine.Methods Pharyngeal and anal swabs were collected from patients admitted to PICU during May 2019 and October 2019.In-house disk screening test and broth-enrichment method were carried out to screen CRE.The results of these two methods were compared.Clinical records were reviewed.Clinical environment was sampled.The medical staff implemented timely interventions for patients with positive CRE screening.WHONET 5.6 was used to calculate CRE infection rate in PICU.Clinical data of CRE-positive patients were reviewed and analyzed.Results The positive rate of CRE was 5.4%screened by the broth-enrichment method,higher than that by the in-house disk screening test.Majority(86.0%)of the CRE strains detected were carbapenem-resistant Klebsiella pneumoniae(CRKP).The prevalence of CRE infection showed a decreasing trend since active CRE screening and intervention measures were implemented in the PICU.Most(70.0%)of the CRE-positive patients had used broad-spectrum antibacterial agents,and most of the patients had a history of digestive tract or respiratory tract surgery.CRE infection occurred in different sites after operation.Conclusions Broth-enrichment method can significantly increase the detection rate of CRE.It is helpful to reduce CRE infection by active CRE screening and effective intervention measures.

关 键 词：耐碳青霉烯类肠杆菌科细菌 主动筛查 临床资料 儿童重症监护病房 干预措施 

分 类 号：R378[医药卫生—病原生物学] R725[医药卫生—基础医学]