重症监护室耐甲氧西林金黄色葡萄球菌监控研究

Surveillance on methicillinresistant Staphylococcus aureus infection in an intensive care unit

摘要:

目的了解某院重症监护室（ICU）耐甲氧西林金黄色葡萄球菌（MRSA）医院感染情况，评价干预效果。方法收集2008年8月—2010年9月间ICU住院患者MRSA医院感染病例，对分离的阳性菌株用分子生物学方法验证。2009年9月—2010年9月，对ICU MRSA医院感染患者实施具体干预、监控，并与干预前一年的MRSA医院感染率进行比较，评价干预效果。结果ICU环境中MRSA检出率，干预前为29.90%（87/291），干预后为7.90%（23/291），两者比较，差异有统计学意义(χ2=45.910，P＜0.05)； ICU住院患者MRSA医院感染率，干预前为35.87％（113/315），干预后为14.66%(51/348)，两者比较，差异有统计学意义(χ2=25.11，P＜0.05)。干预前后ICU内的MRSA感染危险因素相同，主要是气管插管及使用呼吸机等侵入性操作、神经外科大手术、广谱抗菌药物的长期使用、免疫抑制剂的应用和未采取隔离措施等。MRSA新发感染主要集中在入住ICU 2周后，入住时间越长，干预效果越不明显。结论ICU获得性感染MRSA发生率较高。早期强化干预措施，加强监测、控制，可有效降低MRSA医院交叉感染率。

Abstract:

ObjectiveTo investigate methicillinresistant Staphylococcus aureus (MRSA) infection in an intensive care unit (ICU), and evaluate the efficacy of intervention.MethodsFrom August 2008 to September 2010, all MRSA infection cases in ICU were collected, and all isolated MRSA strains were tested by molecular biology method, from september 2009 to September 2010, patients infected with MRSA were intervened and monitored, and compared with MRSA infection rate of one year before intervention, the efficacy of all measures was evaluated.ResultsThe detection rate of MRSA from ICU environment was 29.90%(87/291) before intervention and 7.90% (23/291) after intervention (χ2=45.910, P<0.05); the infection rate of MRSA in ICU patients was 35.87% (113/315) before intervention and 14.66%(51/348) after intervention (χ2=25.11, P<0.05). The risk factors for MRSA infection before and after the intervention were similar, the main risk factors were tracheal intubation and use of ventilator, neurosurgery operation, longterm application of broadspectrum antimicrobial agents, application of immunosuppressive agents, as well as nonisolation, et al．MRSA infection appeared mostly two weeks after patients’ admission, the longer time the patients were in hospital, the less effect of the intervention achieved.Conclusion ICUacquired MRSA infection rate is relatively high, early intensifying strategies, monitor, and control can reduce cross infection rate of MRSA.