ICU多重耐药菌目标性监测与干预效果分析
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刘菁

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R181.3+2

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连云港市科技局资助项目(SH1529)


Efficacy of targeted monitoring and intervention on multidrugresistant organisms in intensive care units
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    摘要:

    目的了解重症监护病房(ICU)多重耐药菌(MDRO)的感染现状,评价目标性监测的干预效果。方法采用前瞻性研究方法,选取2014—2015年入住ICU的患者,2014年1—12月为干预前阶段,2015年1—12月为干预阶段,对比分析干预前后MDRO 感染趋势。结果干预前检出MDRO 297株,干预后检出217株,除CRPA外,干预后耐碳青霉烯类鲍曼不动杆菌(CRAB)、耐碳青霉烯类肠杆菌科细菌(CRE)、耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)检出株数均较干预前减少。ICU MDRO感染率由干预前的7.17‰降至3.88‰,其中CRAB、CRE干预后感染率低于干预前,差异有统计学意义(均P<0.05);综合、内科ICU MDRO感染率分别由干预前的8.75‰、7.84‰,降至干预后的4.39‰、2.28‰,两组比较差异均有统计学意义(均P<0.05)。采取干预措施后,接触隔离医嘱24 h下达率、手卫生依从率、医护人员知晓率等防控措施的依从性较干预前显著提高(均P<0.05)。结论采取目标性监测和干预措施,可降低ICU MDRO检出率。

    Abstract:

    ObjectiveTo understand the status of infection with multidrugresistant organisms (MDROs) in intensive care units(ICUs), and evaluate the intervention efficacy of targeted monitoring.MethodsProspective study was adopted, patients who were admitted to ICUs in 2014-2015 were selected (JanuaryDecember 2014 was as preintervention stage, JanuaryDecember 2015 was as intervention stage), trend of MDRO infection before and after intervention were compared and analyzed.ResultsBefore and after intervention, 297 and 217 strains of MDROs were isolated respectively, except carbapenemresistant Pseudomonas aeruginosa (CRPA), the isolated strains of carbapenemresistant Acinetobacter baumannii (CRAB), carbapenemresistant Enterobacteriaceae (CRE), methicillinresistant Staphylococcus aureus(MRSA), and vancomycinresistant Enterococcus (VRE) declined after intervention. MDRO infection rate declined from 7.17 ‰ before intervention to 3.88‰ after intervention, infection rate of CRAB and CRE after intervention were both lower than before intervention (both P<0.05); MDRO infection rates in general ICU and internal medicine ICU increased from 8.75‰ and 7.84‰ before intervention to 4.39‰ and 2.28‰ after intervention, respectively (both P<0.05). After taking comprehensive intervention measures, compliance to prevention and control measures, such as ordering rate of doctor’s advice on contact isolation for 24 hours, hand hygiene, health care workers’ awareness all enhanced significantly(all P<0.05).ConclusionTargeted monitoring and intervention measures can reduce isolation rate of MDROs in ICUs.

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陈亚男,刘菁,田丽梅,等. ICU多重耐药菌目标性监测与干预效果分析[J]. 中国感染控制杂志,2017,16(1):58-61. DOI:10.3969/j. issn.1671-9638.2017.01.013.
CHEN Yanan, LIU Jing, TIAN Limei, et al. Efficacy of targeted monitoring and intervention on multidrugresistant organisms in intensive care units[J]. Chin J Infect Control, 2017,16(1):58-61. DOI:10.3969/j. issn.1671-9638.2017.01.013.

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  • 收稿日期:2016-05-30
  • 最后修改日期:2016-08-12
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  • 在线发布日期: 2017-01-22
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