医联体内耐碳青霉烯类肠杆菌感染同质化防控管理成效  

Effectiveness of homogeneous management on prevention and control of carbapenem-resistant Enterobacteriaceae infection in medical consortia

作　　者：陈亚男[1,2] 刘菁[1,2] CHEN Ya-nan;LIU Jing(Lianyungang First People's Hospital,Lianyungang,Jiangsu 22206l,China;不详)

机构地区：[1]连云港市第一人民医院感染管理科,江苏连云港222061 [2]连云港市第一人民医院医疗集团感染管理科,江苏连云港222061

出　　处：《中华医院感染学杂志》2023年第11期1751-1755,共5页Chinese Journal of Nosocomiology

基　　金：江苏省医院协会医院管理创新研究课题基金资助项目(JSYGY-3-2021-442);连云港市高新区科技重点研发计划基金资助项目(ZD201933)。

摘　　要：目的在某地级市医联体范围内发挥牵头三甲医院的作用,提升重症监护病房(ICU)内耐碳青霉烯类肠杆菌(CRE)的同质化防控水平。方法自2021年7月起在医联体范围内由牵头三甲医院针对CRE建立并推行基于“行政+临床+医技”的同质化防控模式,收集并对比医联体单位2020年7月-2022年6月管理干预前后ICU内CRE的检出率与感染率,评价成效。结果两年间共监测8个ICU住院患者9230例,共检出肠杆菌1277株,其中CRE 278株,导致医院感染患者101例,而肺炎克雷伯菌占比由62.10%增加到81.19%,呈现增高趋势(P<0.05);推行CRE同质化管理干预后,8个ICU内CRE检出率和感染率分别由干预前的25.74%(157/610)、1.35%(63/4683)降至18.14%(121/667)和0.84%(38/4547)(P<0.05);与此同时,8个ICU的总体医院感染率也由9.29%降至6.42%(P<0.05)。结论通过发挥医联体内牵头三甲医院在耐碳青霉烯肠杆菌防控的作用,构建基于多学科协作的同质化防控体系,能有效提升ICU内耐碳青霉烯肠杆菌科细菌的防控成效。OBJECTIVE To play the leading role of a tertiary hospital within a prefecture-level medical consortium,and to improve the homogeneous prevention and control level of carbapenem-resistant Enterobacteriaceae(CRE)in the intensive care unit(ICU).METHODS Since Jul.2021,a homogeneous prevention and control model based on"Administrative+Clinical+Medical"for CRE was established and implemented in the leading ClassⅲGrade A hospitals within the medical consortium.The detection rate and infection rate of CRE in the ICU before and after the management intervention in the medical consortium units from Jul.2020 to Jun.2022 were collected and compared,and the effectiveness was evaluated.RESULTS During the two years,a total of 9230 patients in 8 ICUs were monitored,and a total of 1277 strains of Enterobacteriaceae were detected,including 278 strains of CRE,resulting in 101 cases of nosocomial infection,while the proportion of Klebsiella pneumoniae increased from 62.10%to 81.19%,showing an increasing trend(P<0.05).After the implementation of CRE homogenization management intervention,the detection rate and infection rate of CRE in 8 ICUs decreased from 25.74%(157/610)and 1.35%(63/4683)before intervention to 18.14%(121/667)and 0.84%(38/4547)(P<0.05),respectively;meanwihle,the overall nosocomial infection rate in the 8 ICUs also decreased from 9.29%to 6.42%(P<0.05),respectively.CONCLUSION By leveraging the role of the leading tertiary hospitals within the medical consortium in the prevention and control of carbapenem-resistant Enterobacteriaceae,and constructing a homogeneous prevention and control system based on multidisciplinary collaboration,the prevention and control effectiveness of carbapenem-resistant Enterobacteriaceae in the ICU can be effectively improved.

关 键 词：医联体 耐碳青霉烯肠杆菌科细菌 同质化 感染防控 

分 类 号：R183[医药卫生—流行病学]