2017-2021年某儿科医院耐碳青霉烯类革兰阴性菌综合干预感控措施效果及其耐药基因  

Evaluation of effectiveness of comprehensive intervention infection prevention and control measures on carbapenem-resistant gram-negative bacilli of drug resistance genes in pediatric hospital in 2017-2021

作　　者：殷丽军[1] 武娜娜[1] 缪瑾[1] 杨韦菁 何磊燕 陆国平[3] 曹云[4] 王来栓 翟晓文 王传清[1,2] YIN Li-jun;WU Na-na;MIAO Jin;YANG Wei-jing;HE Lei-yan;LU Guo-ping;CAO Yun;WANG Lai-shuan;ZHAI Xiao-wen;WANG Chuan-qing(Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院院内感染控制与防保科,上海201102 [2]复旦大学附属儿科医院临床检验中心细菌室,上海201102 [3]复旦大学附属儿科医院儿科重症监护室,上海201102 [4]复旦大学附属儿科医院新生儿重症监护室,上海201102 [5]复旦大学附属儿科医院新生儿科,上海201102 [6]复旦大学附属儿科医院血液科,上海201102

出　　处：《中华医院感染学杂志》2024年第3期410-415,共6页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2021YFC2701805)。

摘　　要：目的评估儿科医院感染高风险部门(新生儿科、新生儿重症监护室、儿科重症监护病房、血液科)耐碳青霉烯类革兰阴性菌(CR-GNB)综合干预措施效果及其耐药基因.方法选取2017-2021年复旦大学附属儿科医院感染高风险部门患儿为研究对象,2017年开始对上述患儿入院后48 h以内以及住院期间每周一次在上呼吸道和肠道进行主动筛查,2018年1月开始对主动筛查及临床送检标本检出CR-GNB阳性患儿实施集中安置,比较CR-GNB主动筛查率、定植率、集中安置率以及医院感染率的变化;同时通过聚合酶链式反应(PCR)检测耐碳青霉烯酶基因,对其耐药机制进行研究.结果2017-2021年肛咽拭子CR-GNB主动筛查率均逐年增加(P<0.001),上述高风险部门共有28.46%(916/3219)CR-GNB阳性患儿采取了A/B集中安置措施,随着A/B集中安置率的提高,住院时间>7 d的患儿CR-GNB定植率呈现下降趋势(P<0.001),同时医院感染率从2017年的1.16%(153/13190)下降到2021年的0.29%(28/9774)(P<0.001);耐碳青霉烯类肺炎克雷伯菌主要耐药基因是blaNDM-i(52.00%,26/50)、blaKPC-2(42.00%,21/50)和blaDHA-i(26.00%,13/50),耐碳青霉烯类鲍氏不动杆菌均检出blaOXA-23耐药基因,仅有3株耐碳青霉烯铜绿假单胞菌检出耐药基因,1株为blaBIC,2株为blaVIM-2.结论对感染高风险部门进行CR-GNB主动筛查及A/B等级的隔离安置措施能降低CR-GNB定植及医院感染率.OBJECTIVE To evaluate the effectiveness of comprehensive interventions for carbapenem-resistant gram-negative bacilli(CR-GNB)in high-risk departments for pediatric hospital-acquired infections(neonatal unit,NICU,PICU,and hematology department)and their resistance genes.METHODS Children in the high-risk de-partments for pediatric hospital-acquired infections of Fudan University Pediatric Hospital were selected as the study subjects from 2017 to 2021,and active screening in the upper respiratory tract and intestines of the above children within 48 hours after admission and once a week during hospitalization was stared in 2017,and centralized placement was implemented for the CR-GNB-positive children detected by the active screening and the clinically delivered specimens from January 2018,and the changes of active screening rate,colonization rate,various patient placement rate,and nosocomial infection rate of CR-GNB were compared.The mechanism of resistance was also investigated by detecting carbapenemase-resistant genes by polymerase chain reaction(PCR).RESULTS The active screening rate of CR-GNB in anal-pharyngeal swabs increased year by year from 2017 to 2021(P<0.001),and a total of 28.46%(916/3219)of CR-GNB-positive children in high-risk departments mentioned above were subjec-ted to centralized placement in A/B,and with the increase in the rate of centralized placement in A/B,the rate of CR-GNB colonization in children with hospitalization time>7 d showed a decreasing trend(P<0.001),while the rate of nosocomial infections decreased from 1.16%(153/13190)in 2017 to 0.29%(28/9774)in 2021(P<0.001).The predominant carbapenem-resistant Klebsiella pneumoniae resistance genes were blaNDM-i(52.00%,26/50),blaKPC-2(42.00%,21/50),blaDHA-i(26.00%,13/50),while all carbapenem-resistant Acinetobacter bau-mannii were detected with the blaOXA-23 resistance gene,and only three carbapenem-resistant strains of Pseudo-monas aeruginosa were detected with the resistance gene,one with blaBiC,and two with bla viM-2.CONCLUSION Active CR-

关 键 词：主动筛查 病人安置 耐碳青霉烯类革兰阴性菌 定植 KPC NDM OXA-23 综合干预感控措施 感染监测 

分 类 号：R378[医药卫生—病原生物学]