高危科室住院患者肠道耐碳青霉烯类肠杆菌科细菌筛查及其阳性危险因素  

Screening of intestinal carbapenem-resistant Enterobacteriaceae for hospitalize patients of high-risk department and risk factors for positive testing

作　　者：刘思娣 吴安华[1] 李春辉[1] 汪要望 付陈超[1] 孟秀娟[1] 曾翠[1] 范鹏超 黄勋[1] LIU Si-di;WU An-hua;LI Chun-hui;WANG Yao-wang;FU Chen-chao;MENG Xiu-juan;ZENG Cui;FAN Peng-chao;HUANG Xun(Xiangya Hosptial,Central South University,Changsha,Hunan 410008,China)

机构地区：[1]中南大学湘雅医院感染控制中心,湖南长沙410008 [2]大连医科大学附属第二医院感染控制部,辽宁大连116023

出　　处：《中华医院感染学杂志》2023年第4期517-521,共5页Chinese Journal of Nosocomiology

基　　金：湖南省卫生健康委科研计划基金资助项目(20201422)。

摘　　要：目的 了解某三甲医院高危科室的住院患者肠道耐碳青霉烯类肠杆菌科细菌(CRE)的筛查情况以及探讨肠道CRE阳性的危险因素,为CRE的防控提供参考依据.方法 回顾性调查医院2020年1月1日-2021年6月30日入住重症监护病房、骨髓移植科、器官移植科、血液科,并进行肠道CRE筛查的住院患者;然后将住院期间大便CRE由持续阴性(≥1次)转为阳性(≥1次)的患者纳入病例组,将大便CRE持续阴性≥3次的患者纳入对照组,分析肠道CRE阳性的危险因素.结果 高危科室共878例住院患者进行肠道CRE筛查,筛查率为7.51%(878/11 697),阳性率为18.79%(165/878);肠道CRE筛查率最高的高危科室为呼吸重症监护病房(38.50%),肠道CRE阳性率最高的高危科室为综合重症监护病房(35.97%);165例大便CRE阳性患者共检出170株细菌,以肺炎克雷伯菌为主(85.88%);病例组大便CRE由阴性转为阳性的平均时间为6天;年龄≥60岁、留置胃管是高危科室住院患者CRE阳性的危险因素(均P<0.05).结论 建议对高危科室患者加强肠道CRE筛查,尤其是高龄和留置胃管患者,及早采取有效的防控措施,减少交叉传播和感染.OBJECTIVE To understand the screening of intestinal carbapenem-resistant Enterobacteriaceae(CRE)in inpatients of a tertiary care hospital in high-risk units and to explore the risk factors for intestinal CRE positivity,to provide reference basis for the prevention and control of CRE.METHODS Inpatients admitted to the intensive care unit,bone marrow transplantation unit,organ transplantation unit,and hematology unit at our hospital from Jan.l,2020,to Jun.30,2021 who underwent screening for intestinal CRE were retrospectively surveyed.Patients whose fecal CRE changed from persistently negative(≥1)to positive(≥1)during hospitalization were then included in the case group,and those with persistently negative fecal CRE≥3 times were included in the control group,and the risk factors for positive intestinal CRE were summarized.RESULT A total of 878 inpatients were screened for intestinal CRE in high-risk units,with a screening rate of 7.51%(878/11697)and a positive rate of 18.79%(165/878).The high-risk unit with the highest rate for intestinal CRE screening was the respiratory intensive care unit(38.50%),and the high-risk unit with the highest rate of positive intestinal CRE was the general intensive care unit(35.97%).A total of 170 bacterial strains were detected in 165 patients with positive stool CRE,with Klebsiella pneumoniae predominating(85.88%).The average time to change from negative to positive stool CRE in the case group was 6 days.Age≥60 years and indwelling gastric tube were risk factors for positive CRE in patients hospitalized in high-risk units(all P<O.05).CONCLUSION It is recommended to strengthen intestinal CRE screening for patients in high-risk units,especially for elderly and indwelling gastric tube patients,and early and effective preventive and control measures should be taken to reduce cross-transmission and infection.

关 键 词：高危科室 耐碳青霉烯类肠杆菌科细菌 住院患者 肠道CRE阳性 筛查 定植 感染 危险因素 

分 类 号：R378[医药卫生—病原生物学]