咽拭子联合肛拭子作为ICU多重耐药菌入院筛查的有效性评估

Effectiveness evaluation of pharyngeal swabs combined with anal swabs as multidrug-resistant organisms admission screening in intensive care unit

摘要:

目的 评估咽拭子联合肛拭子作为重症监护室（ICU）患者多重耐药菌（MDRO）入院筛查的有效性，为医院感染防控策略提供参考依据。 方法 选取上海地区某院2022年8月1日—12月31日入住ICU 24 h内进行咽拭子联合肛拭子MDRO入院筛查的患者作为试验组，2021年8月1日—12月31日入住ICU 24 h内进行咽拭子MDRO入院筛查的患者作为对照组。比较两组MDRO的入院筛查阳性率、医院感染情况、菌株种类，以及试验组MDRO联合入院筛查的灵敏度及特异度。 结果 共纳入917例患者，其中试验组442例，对照组475例。试验组与对照组患者MDRO入院筛查阳性率分别为7.40%、3.37%，试验组与对照组患者MDRO医院感染发病率分别为2.71%、5.68%，试验组与对照组患者消化系统MDRO医院感染发病率分别为0.68%、2.32%，差异均有统计学意义（均P < 0.05）。咽拭子联合肛拭子的入院筛查方式对预测患者MDRO医院感染的受试者工作特征（ROC）曲线下面积为0.897（P < 0.01，95%CI：0.802~0.993）；试验组咽拭子联合肛拭子MDRO入院筛查灵敏度为72.73%，特异度为97.65%。 结论 咽拭子联合肛拭子可以作为ICU MDRO的入院筛查手段，具有重要的临床应用价值。

Abstract:

Objective To evaluate the effectiveness of pharyngeal swabs combined with anal swabs as multidrug-resistant organism (MDRO) admission screening for patients in intensive care unit (ICU), and provide reference for healthcare-associated infection (HAI) prevention and control strategies. Methods Patients who underwent MDRO admission screening by pharyngeal swabs combined with anal swabs within 24 hours of admission to an ICU of a hospital in Shanghai from August 1 to December 31, 2022 were included as the experimental group, and those who underwent MDRO admission screening only by pharyngeal swabs from August 1 to December 31, 2021 were as the control group. Positive rate of screening, occurrence and pathogen of HAI between the two groups, as well as the sensitivity and specificity of combined admission screening for MDRO in the experimental group were compared. Results A total of 917 patients were included in the study, with 442 cases in the experimental group and 475 cases in the control group. The positive rates of admission screening for MDRO in the experimental and control groups were 7.40% and 3.37%, respectively. The incidences of HAI with MDRO in the experimental and control groups were 2.71% and 5.68%, respectively. Incidences of digestive system HAI with MDRO in the experimental and control groups were 0.68% and 2.32%, respectively. Differences were all statistically significant (all P < 0.05). The area under the ROC curve of admission screening by pharyngeal swabs combined with anal swabs for predicting HAI with MDRO in patients were 0.897 (P < 0.01, 95%CI: 0.802-0.993). The sensitivity and specificity of admi-ssion screening for MDRO by pharyngeal swabs combined with anal swabs in the experimental group were 72.73% and 97.65%, respectively. Conclusion The combination of pharyngeal swabs and anal swabs can be used as an ICU admission screening method for MDRO, and has an important clinical application value.