非重症监护病房多重耐药菌感染来源及分布  

Source and distribution of multidrug-resistant organisms infections in non-intensive care unit

作　　者：李占结 张永祥 周苏明 刘波 武星[3] Li Zhanjie;Zhang Yongxiang;Zhou Suming;Liu Bo;Wu Xing(Infection Management Department,The First Affiliated Hospital of Nanjing Medical University,Nanjing 221900,China;Geriatric Intensive Care Unit,The First Affiliated Hospital of Nanjing Medical University,Nanjing 221900,China;Infection Management Department,Jiangnan University Hospital,Wuxi 214062,China)

机构地区：[1]南京医科大学第一附属医院感染管理处,南京市221900 [2]南京医科大学第一附属医院老年重症监护病房,南京市221900 [3]江南大学附属医院感染管理处,无锡市214062

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第1期1-8,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家重点研发科技攻关项目(No.2020YFC0848100);中国老年医学学会感染防控研究基金资助项目(No.GRYJ-LRK2018016);江苏省医院管理创新研究基金资助项目(No.JSYGY-3-2019-484)。

摘　　要：目的:分析非重症监护病房(ICU)多重耐药菌(MDRO)感染来源及分布,为制定精准化MDRO防控措施提供依据。方法:选取南京医科大学第一附属医院2017年10月至2019年9月802例自非ICU科室MDRO感染者体内分离出的1116株MDRO菌株作为研究对象,依据来源将MDRO分为院外感染(外院转入、社区获得)和院内感染(本院转入、科室获得)两大类型共4个组别进行分析。结果:本院非ICU科室感染的MDRO以碳青霉烯类耐药肠杆菌科(CRE)(384/1116、34.41%)及耐甲氧西林金黄色葡萄球菌(MRSA)(331/1116、29.66%)为主;不同科室MDRO感染构成差异有统计学意义(χ^(2)=185.687、P<0.001),4种常见MDRO感染最多的科室为老年医学科(147/1116、13.17%)、神经外科(112/1116、10.04%)和康复医学科(95/1116、8.51%)。CRE、MRSA、碳青霉烯类耐药鲍曼不动杆菌(CRAB)和碳青霉烯类耐药铜绿假单胞菌(CRPA)检出率分别为10.69%(704/6584)、43.83%(554/1264)、33.72%(376/1115)和27.11%(475/1752),均显著低于全院科室CRE、MRSA、CRAB、CRPA的平均检出率[25.35%(3474/13704)、51.48%(1093/2123)、79.15%(4704/5943)和46.99%(2051/4365)],差异均有统计学意义(χ^(2)=584.309、15.583、960.632、203.726,P均<0.001);非ICU科室间以上4种MDRO检出率差异均有统计学意义(χ^(2)=190.766、97.642、75.078和69.515,P均<0.001)。MDRO感染部位主要为下呼吸道(540/1116、48.39%)、手术部位(132/1116、11.83%)和泌尿道(123/1116、11.02%)。院外感染者共641例(57.44%),包括外院转入(373/1116、33.42%)和社区获得(268/1116、24.01%);院内感染者475例(42.56%),包括本院转入(52/1116、4.66%)和科室获得(423/1116、37.90%)。结论:本院非ICU科室MDRO感染近2/3来源于院外输入和院内转入,需重视感染控制基本措施落实并通过信息系统早期识别,且各科室间MDRO感染来源及分布不同,应根据其特点制定针对性措施,实现精准化防控。Objective To investigate the source and distribution of multidrug-resistant organisms(MDRO)infection in non-intensive care unit(ICU),and to provide basis for accurate prevention and control measures of MDRO.Methods Total of 1116 MDRO strains isolated from 802 patients with MDRO infection in the non-ICU departments of Jiangsu Provincial people’s Hospital from October 2017 to September 2019 were selected.According to the source,MDRO were divided into two types:out-of-hospital infection(transferred from outside hospital and community acquired)and nosocomial infection(transferred from our hospital and acquired from departments of our hospital).Results The main MDRO in non-ICU departments were carbapenem-resistant Enterobacteriaceae(CRE)(384/1116,34.41%)and methicillinresistant Staphylococcus aureus(MRSA)(331/1116,29.66%).There were significant differences in the composition of MDRO infection among different departments(χ^(2)=185.687,P<0.001).The departments with the most common MDRO infection were geriatrics(147/1116,13.17%),neurosurgery(112/1116,10.04%)and rehabilitation medicine(95/1116,8.51%).The detection rates of CRE,MRSA,carbapenemresistant Acinetobacter baumannii(CRAB)and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 10.69%(704/6584),43.83%(554/1264),33.72%(376/1115)and 27.11%(475/1752),respectively,which were significantly lower than those of departments from the whole hospital[25.35%(3474/13704),51.48%(1093/2123),79.15%(4704/5943)and 46.99%(2051/4365)],with significant differences(χ^(2)=584.309,15.583,960.632,203.726;all P<0.001).There were significant differences in the detection rates of the above four kinds of MDRO among different non-ICU departments(χ^(2)=190.766,97.642,75.078,69.515;all P<0.001).The most common sites of MDRO infection were lower respiratory tract(540/1116,48.39%),operation site(132/1116,11.83%)and urinary tract(123/1116,11.02%).There were 641 cases of out-of-hospital infection(57.44%),including out-of-hospital transfer(373/1116,33.42%)and community access(268/1116,24.01%);a

关 键 词：多重耐药菌 重症监护病房 分布 来源 

分 类 号：R446.5[医药卫生—诊断学]