某三甲医院2021—2023年耐碳青霉烯类肠杆科细菌主动筛查结果及干预效果研究  

Active screening results and intervention effects of carbapenem-resistant Enterobacteriaceae in third class hospital from 2021 to 2023

作　　者：李俊骏 范娟[1] LI Jun-jun;FAN Juan(Hospital Infection Management Office,the Second Peoples Hospital of Nanyang,Nanyang,Henan 473000,China)

机构地区：[1]南阳市第二人民医院感染管理办公室,河南南阳473000

出　　处：《医药论坛杂志》2025年第2期132-137,共6页Journal of Medical Forum

基　　金：南阳市科技攻关计划项目(KJGG080)。

摘　　要：目的 对所有入住南阳市第二人民医院监护室的患者进行耐碳青霉烯类肠杆科细菌(carbapenem-resistant Enterobacteriaceae,CRE)主动筛查,降低监护室CRE传播风险,丰富CRE主动筛查监测数据,为临床医生经验性用药提供参考。方法 对南阳市第二人民医院2021年6月至2021年12月各监护室的住院患者进行CRE主动筛查,明确CRE肠道定植高风险人群为入住神外监护室和呼吸监护室的患者,2022年1月—2023年12月期间,持续对入住神外监护室和呼吸监护室的患者进行CRE主动筛查,并对所有筛查阳性患者采取隔离干预措施,同时收集CRE筛查阳性患者相关临床资料,追踪阳性患者结局,对相关资料进行分析,比较CRE主动筛查及干预措施落实前后CRE筛查阳性率、CRE检出率和CRE医院感染率的变化。结果 南阳市第二人民医院各监护室CRE筛查阳性患者44.00%(22/50)分布在呼吸监护室,36.00%(18/50)分布在神外监护室;上述两科室中主动筛查出的CRE菌株中96.51%(83/86)是碳青霉烯类耐药肺炎克雷伯菌;67.44%(58/86)的CRE筛查阳性患者为住院1周以后CRE主动筛查结果呈阳性。CRE筛查阳性患者其他部位CRE感染率和病死率分别是40.70%和20.93%,均高于CRE筛查阴性患者(P<0.05)。呼吸及神外监护室3 961名主动筛查患者中,有碳青霉烯类抗菌药物应用史的患者,CRE筛查阳性率4.10%,高于无碳青霉烯类抗菌药物应用史的患者(1.24%)(P<0.05)。监护室CRE主动筛查的阳性率、其他标本微生物培养CRE检出率和CRE医院感染发病率随着对CRE主动筛查阳性患者的隔离干预逐渐降低。结论 CRE肠道定植患者主要分布在呼吸监护室和神外监护室;肠道CRE定植菌主要以碳青霉烯类耐药肺炎克雷伯菌为主;碳青霉烯类抗菌药物应用史是CRE肠道定植患者的高危因素;肠道定植CRE的患者发生其他部位CRE感染的风险较高,且预后不良;CRE主动筛查和阳性患者隔离干预能够�Objective To undertake active screening of carbapenem-resistant Enterobacteriaceae(CRE) for all patients admitted to the intensive care unit(ICU),the Second People's Hospital of Nanyang,and minimize the risk of CRE transmission within the ICU,augment the monitoring data of active CRE screening and furnish a reference for empirical medication for clinicians.Methods Active CRE screening was implemented for all inpatients in the ICU of the Second Peoples Hospital of Nanyang from June 2021 to December 2021 to identify the high-risk population of CRE intestinal colonization.The high-risk population were patients admitted to the neurosurgery ICU and the respiratory ICU.Continuous active screening was carried out for the high-risk population from January 2022 to December 2023.and isolation and intervention measures were adopted for all screening-positive patients.Simultaneously,relevant clinical data of CRE screening-positive patients were collected,the outcomes of positive patients were tracked,and the relevant data were analyzed to compare the alterations in the positive rate of CRE screening,the detection rate of CRE,and the nosocomial infection rate of CRE before and after the execution of active CRE screening and intervention measures.Results There were 44.00%(22/50) of CRE screening-positive patients in each ICU of the Second People's Hospital of Nanyang were distributed in the respiratory ICU,and 36.00%(18/50) in the neurosurgery ICU.Among the actively screened CRE strains,in the above two departments,96.51%(83/86) were carbapenem-resistant klebsiella pneumoniae.Among 67.44%(58/86) of CRE screening-positive patients had positive active CRE screening results one week after hospitalization.The infection rate and mortality rate of CRE in other sites of CRE screening-positive patients were 40.70% and 20.93%,respectively,both higher than those of CRE screening-negative patients(P<0.05).Among the 3 961 patients who underwent active screening in the Respiratory and Neurosurgical Intensive Care Units.The positive rate of

关 键 词：耐碳青霉烯类肠杆菌科细菌 重症监护室 主动筛查 感染防控 

分 类 号：R446.5[医药卫生—诊断学]