目的分析重症监护病房(Intensive Care Unit,ICU)多药耐药菌(Multidrug-resistant Organisms,MDRO)感染分布及来源,为制定更有效的MDRO防控方案提供依据。方法回顾性调查某大型三甲医院2017年7月-2018年6月期间,全院8个ICU中MDRO感染情况,依据来源将8个ICU的MDRO分为院外感染(外院转入、社区获得)和院内感染(本院转入、科室获得)两大类型4个组别进行分析研究。结果感染的MDRO中以CRAB(64.8%)和CRE(20.09%)为主;MDRO检出率MRSA 49.75%、CRAB 90.47%、CRPA 55.06%、CRE40.46%均高于2017年全国细菌耐药监测网数据;MDRO感染部位分布前三位分别为下呼吸道感染85.04%、血流感染4.69%和手术部位感染3.79%;MDRO院外感染和院内感染分别为50.89%和49.11%,其中MRSA、CRAB、CRPA、CRE的院外感染比例分别为47.36%、54.04%、58.97%、38.33%,而科室获得的MDRO感染来源分别为43.86%、40.69%、37.18%、52.78%;综合性ICU与专科性ICU病房CRAB感染在社区获得、本院转入和科室获得等来源上差异有统计学意义(P<0.05)。结论 ICU超过一半的MDRO感染由外院转入或社区获得,应加强对MDRO来源的识别,有针对性地采取更为有效的精准化感染防控措施。
OBJECTIVE To analyze the distribution and source of multiple drug-resistant organisms in the Intensive Care Unit, ICU, to provide the basis for a more effective multi-drug-resistant bacterial control program. METHODS A retrospective investigation has been conducted on the MDRO infection of multi-drug resistant microorganisms (MDROs) in 8 ICUs in a large-scale tertiary class-A hospital from Jul. 2017 to Jun. 2018. According to the source, the MDROs in 8 ICUs were divided into 4 groups, namely, out-of-hospital infection (intra-hospital transfer, community acquisition) and in-hospital infection (in-hospital transfer, department acquisition) for analysis and study. RESULTS CRAB (64.8%) and CRE (20.09%) were the majority of the infected MDROs. MRSA (49.75%), CRAB (90.47%), CRPA (55.06%) and CRE (40.46%) were all higher than the data of 2017 national bacterial resistance monitoring network. The top three MDRO infection sites were lower respiratory tract infection (85.04%), bloodstream infection (4.69%) and surgical site infection (3.79%). The out-of-hospital and in-hospital infection rates of MDRO were 50.89% and 49.11%, respectively. The out-of-hospital infection rates of MRSA, CRAB, CRAB, CRPA and CRE were 47.36%, 54.04%, 5&97% and 38.33%, respectively. The source of MDRO infection obtained by the department was 43.86%, 40.69%, 37.18% and 52.78%, respectively. There was a significant difference between comprehensive ICU and specialized ICU wards in CRAB infection of community acquisition, hospital transfer, department acquisition and other sources (P<0.5). CONCLUSION More than half of the MDROs infections in the ICUs are transferee, outside the hospital or community-acquired. We should strengthen the identification of the MDRO source and take more effective and precise infection prevention and control measures.
Chinese Journal of Nosocomiology
Multi-drug resistant bacteria
Intensive care unit (ICU)