应用主动筛查预防与控制重症监护病房患者多重耐药菌感染

Application of active screening to prevent and control multidrug-resistant organism infection in patients in intensive care unit

摘要:

目的 通过对重症监护病房（ICU）患者采用主动筛查，分析主动筛查在ICU多重耐药菌（MDRO）感染预防与控制中的作用。 方法 选取2017年1月1日-2020年12月31日所有入住某院急诊ICU的患者，2017-2018年未进行主动筛查的患者为对照组，2019-2020年进行主动筛查的患者为干预组。比较两组患者感染情况、MDRO感染情况及医疗不良事件发生情况。 结果 对照组共1 834例患者，医院感染发病率7.91%；干预组共1 636例患者，医院感染发病率5.26%；两组比较差异有统计学意义（P=0.002）。对照组中MDRO感染患者58例，感染率3.16%；干预组中MDRO感染患者33例，感染率2.02%；两组比较差异有统计学意义（P=0.035）。干预组耐碳青霉烯类鲍曼不动杆菌（CRAB）、多重耐药/泛耐药铜绿假单胞菌（MDR/PDR-PA）、产超广谱β-内酰胺酶（ESBLs）细菌的例次感染率均低于对照组，差异有统计学意义（均P < 0.05）。MDRO呼吸道感染率对照组为2.84%，干预组为1.77%，两组比较差异有统计学意义（P=0.038）。干预组的平均总住院日数、ICU住院日数均低于对照组，差异有统计学意义（均P < 0.05）。干预组MDRO感染患者医疗不良事件发生率低于对照组（6.06% VS 25.86%），差异有统计学意义（P=0.006）。主动筛查阳性率与细菌学培养阳性率比较，差异无统计学意义（P=0.067），主动筛查灵敏度为87.13%，特异度为97.29%。 结论 实施主动筛查可以早期识别MDRO携带者，尽早了解MDRO感染和定植情况，可降低ICU患者医院感染率和MDRO感染率，降低住院日数和医疗不良事件发生率。

Abstract:

Objective To analyze the role of active screening in the prevention and control of multidrug-resistant organism (MDRO) infection in intensive care unit (ICU) through active screening on patients in ICU. Methods Patients who were admitted to the emergency ICU of a hospital from January 1, 2017 to December 31, 2020 were selected, patients who didn't conduct active screening from 2017 to 2018 were in control group, those who underwent active screening from 2019 to 2020 were in intervention group. Infection status, MDRO infection and adverse medical events of two groups of patients were compared. Results A total of 1 834 patients were in control group, incidence of healthcare-associated infection (HAI) was 7.91%; 1 636 patients were in intervention group, HAI rate was 5.26%; there was significant difference between two groups (P=0.002). 58 patients (3.16%) in control group and 33 patients (2.02%) in intervention group had MDRO infection, there was significant difference between two groups (P=0.035). Case infection rates of carbapenem-resistant Acinetobacter baumannii (CRAB), multidrug-resistant/pandrug-resistant Pseudomonas aeruginosa (MDR/PDR-PA) and extended-spectrum β-lactamases(ESBLs)-producing bacteria in intervention group were all lower than those in control group (all P < 0.05). MDRO respiratory tract infection rates in control group and intervention group were 2.84% and 1.77% respectively, there was significant difference between two groups (P=0.038). The average total hospitalization days and ICU hospita- lization days in intervention group were both lower than those in control group (both P < 0.05). Incidence of adverse medical events in patients with MDRO infection in intervention group was lower than that in control group (6.06% vs 25.86%), difference was statistically significant (P=0.006). There was no significant difference in positive rate of active screening and that of bacterial culture (P=0.067), the sensitivity and specificity of active screening were 87.13% and 97.29% respectively. Conclusion Implementation of active screening can early identify MDRO car-riers, understand MDRO infection and colonization as early as possible, reduce HAI rate and MDRO infection rate of ICU patients, and reduce hospitalization days and incidence of adverse medical events.