重症监护病房多重耐药菌主动筛查及定植与感染状况调查分析

目的对某院4个重症监护病房患者多重耐药菌感染/定植状况进行调查分析,为预防和控制多重耐药菌在医院内传播,降低医院感染率提供依据。方法实时查阅病历,询问患者临床症状,主动收集患者肛拭子、咽拭子、鼻拭子、大便等标本,用显色培养基筛查(ESBLs)大肠埃希菌、(ESBLs)肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE),结合临床微生物检验报告(2010年1月1日～2010年8月12日),对多重耐药菌的感染与定植状况、医院感染的危险因素等进行分析。结果患者入住ICU48h内、48h后均有多重耐药菌的感染与定植,而以(ESBLs)大肠埃希菌为主。(ESBLs)大肠埃希菌、耐甲氧西林金黄色葡萄球菌(MRSA)、(ESBLs)肺炎克雷伯菌、耐万古霉素肠球菌(VRE)的定植率(无感染症状)分别为42.86%、25.00%、42.86%、28.57%;感染率(有感染症状)分别为57.14%、75.00%、57.14%、71.43%。患者中有62.70%使用过抗菌药物,21.50%接受过气管插管,32.95%接受过呼吸机,2.27%接受过动静脉导管插管,4.00%接受过留置导尿管,12.40%使用过激素治疗。结论 ESBLs大肠埃希菌是ICU定植和感染的主要多重耐药菌。主动筛查多重耐药菌感染和定植状况,及时发现多重耐药菌,第一时间报告临床,采取消毒隔离措施,及时对患者进行治疗,切断多重耐药菌传播途径,降低或避免多重耐药菌医院感染。

Investigation on infection and colonization status of multi-drug resistant bacteria from ICU patients

OBJECTIVE To investigate the infection and colonization status of multi-drug resistant bacteria from patients in 4 intensive care units(ICUs)of our hospital,and to provide the basis for prevention and control nosocomial infection caused by multi-drug resistant bacteria and reducing the infection rate.METHODS Anal swabs,throat swabs,nasal swabs,stool and other samples from patients in 4 ICUs were collected,Escherichia coli and Klebsiella pneumoniaebacteria strains producing extended-spectrum β-lactamases(ESBLs)and methicillin resistant Staphylococcus aureus(MRSA),vancomycin-resistant Enterococcus(VRE)were screened by chromogenic media.Infection or colonization status of multi-drug resistant bacteria and risk factors of nosocomial infection were analyzed according to medical clinical records,clinical symptoms of patients and clinical microbiological reports from January 1,2010 to August 12,2010.RESULTS Infection and colonization status of multi-drug resistant bacteria were found in patients entering ICU before and after 48 hours,and the main strain was ESBL-producing Escherichia coli.The rate of colonization(no symptoms of infection)of ESBL-producing Escherichia coli,MRSA,ESBL-producing Klebsiella pneumonia and VRE was 42.86%,25.00%,42.86%,and 28.57% respectively,while the rate of infection(symptoms of infection)was 57.14%,75.00%,57.14% and 71.43% respectively.Among these patients,the rate of treatment with antibiotics,tracheal intubation,mechanical ventilation,arterial or venous catheters,indwelling urinary catheter and hormone was 62.70%,21.50%,32.95%,2.27%,4.00% and 12.40% respectively.CONCLUSION ESBL-producing E.coli is a major multi-drug resistant bacterium which leads to colonization and infection in ICU patients.Nosocomial infection caused by multi-drug resistant bacteria will be reduced or avoided through actively screening the status of infection and colonization,monitoring and reporting to clinical immediately,taking disinfection and isolation measures,treating patients timely and cutting off the route of transmission.