综合干预措施对ICU患者呼吸道多重耐药菌感染/定植的防控效果

Effect of comprehensive intervention measures on preventing and controlling multidrugresistant organism infection/colonization in respiratory tract of intensive care unit patients

摘要:

目的探讨综合干预措施对重症监护病房（ICU）患者呼吸道多重耐药菌（MDRO）感染/定植的防控效果。方法对每例监测对象于入院第1、4、8天及之后每间隔7天采集咽拭子和人工气道吸痰标本，并送细菌培养及药敏试验。2013年6—12月为干预前组，2014年1月开始实施综合干预措施，2014年6—12月为干预后组，统计MDRO检出情况。结果共检出253株MDRO，干预前后分别为164、89株，其中检出耐碳青霉烯类鲍曼不动杆菌（CRAB）191株（占75.49%），干预前后分别为119、72株。患者呼吸道MDRO感染发病率干预前组为52.94%，干预后组为30.43%，差异有统计学意义（χ2=5.02，P=0.03）。患者平均住院时间干预前组为（8.07±2.52）d，干预后组为（6.89±1.71）d，差异有统计学意义（t=5.40，P＜0.01）。结论MDRO为ICU医院感染重要病原菌，采取有效综合干预措施可减少患者医院感染的发生。

Abstract:

ObjectiveTo evaluate the effect of comprehensive intervention measures on preventing and controlling the infection/colonization of multidrugresistant organism(MDRO) in respiratory tract of intensive care unit(ICU) patients.MethodsThroat swabs and sputum specimens from artificial airway suction were taken for bacterial culture and antimicrobial susceptibility testing at the first, fourth, eighth day, and then every seven day of patients’ admission. JuneDecember 2013 was as preintervention group, from January 2014, comprehensive intervention measures began to be implemented, JuneDecember 2014 was as postintervention group, detection of MDROs were analyzed statistically.ResultsA total of 253 isolates of MDROs were detected, before and after intervention were 164 and 89 isolates respectively, 191 isolates（75.49%） were carbapenemresistant Acinetobacter baumannii strains, before and after intervention were 119 and 72 isolates respectively. Incidence of MDRO respiratory tract infection before and after intervention were 52.94% and 30.43% respectively, difference was significant(χ2=5.02，P=0.03）. The average hospitalization time of patients in pre and postintervention groups were (8.07±2.52) days and (6.89±1.71） days respectively, difference was significant （t=5.40，P＜0.01）.ConclusionMDROs are major pathogens causing healthcareassociated infection (HAI) in ICU patients, comprehensive intervention measures can reduce the occurrence of HAI.