重症监护病房铜绿假单胞菌医院感染暴发调查与对策

目的对重症监护病房(ICU)发生铜绿假单胞菌感染的暴发进行调查,为控制医院感染提供依据和对策。方法按《医院消毒技术规范》要求采样,按《全国临床检验操作规程》细菌分离培养进行细菌鉴定和药敏试验。结果环境中铜绿假单胞菌检出率从高到低依次为吸痰盘100.0%、护工手66.7%、水龙头50.0%、呼吸机螺纹管道40.0%、治疗盘40.0%、医师手25.0%、床头柜16.7%,患者痰标本及环境中分离到的铜绿假单胞菌具有相同的药敏谱:对环丙沙星、阿米卡星、妥布霉素敏感,对头孢他啶、头孢吡肟、哌拉西林/他唑巴坦及亚胺培南/西司他丁耐药。结论此次暴发的感染源为1例铜绿假单胞菌的定植者,暴发原因为呼吸机螺纹管消毒不彻底及医院人员手卫生落实不够,为预防医院感染,应做好患者隔离、加强医务人员手卫生、严格执行无菌技术与呼吸机管道的管理。     

Risk factors for infection and molecular typing in patients in the intensive care unit colonized with nosocomial Enterobacter aerogenes.

OBJECTIVES: To determine the frequency of colonization by Enterobacter aerogenes in patients in the intensive care unit (ICU) for more than 48 hours and to evaluate the risk factors for infection in patients colonized by this bacteria. DESIGN: An 8-month prospective study. SETTING: A 12-bed medical-surgical ICU in a 450-bed, university-affiliated, tertiary-care hospital in Belgium. METHOD: Pulsed-field gel electrophoresis was used to determine the genotypes of E. aerogenes isolates. RESULTS: We observed two major clones of E. aerogenes in the ICU. Interestingly, 87.5% of infected patients had the same genomic profile for colonization and infection. Risk factors for infection in this particular population included younger age, prolonged hospital stay, mechanical ventilation, and bronchoscopy. CONCLUSIONS: Colonization is a major prerequisite for infection. The identification of risk factors for infection in colonized patients can optimize the quality of treatment in the ICU.     

重症监护病房鲍氏不动杆菌感染分布及预防控制措施

目的了解重症监护病房(ICU)鲍氏不动杆菌的分布及耐药性,旨在为制定预防和控制措施提供依据。方法对2007年1月-2009年12月ICU送检标本分离到的91株鲍氏不动杆菌相关资料进行回顾性分析。结果 2007年1月-2009年12月共分离出鲍氏不动杆菌91株,主要来源于呼吸道标本占89.01%,其次为创面分泌物占7.69%;2007年耐药率>50.00%的抗菌药物只有5种,2008年15种抗菌药物的耐药率均>60.00%,2009年的耐药现象更为严重,15种常用抗菌药物中的12种耐药率>90.00%,泛耐药鲍氏不动杆菌的检出率逐年增加。结论鲍氏不动杆菌主要见于下呼吸道感染,感染率及耐药性逐年增加,加强无菌操作技术和手卫生管理规范,严格各项诊疗技术操作规范,合理使用抗菌药物等措施可有效预防和控制鲍氏不动杆菌的流行。     

重症监护病房铜绿假单胞菌的分布及耐药性分析

目的探讨重症监护病房(ICU)铜绿假单胞菌(PAE)医院感染的标本分布及耐药性,为临床控制PAE医院感染提供依据。方法回顾性调查医院ICU 2008年1月-2009年12月PAE感染的临床现状,对140株PAE的药敏试验结果进行统计分析。结果医院ICU PAE主要来源于呼吸道标本,占总数的55.8%;PAE对头孢噻肟、庆大霉素、氨曲南、左氧氟沙星、磺胺甲噁唑/甲氧苄啶等耐药率均>68.0%,对其他抗菌药物也产生了不同的耐药性;而对亚胺培南、美罗培南、阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦敏感率均>74.0%。结论临床医师应根据病原学检查的结果,合理使用抗菌药物,提高抗感染治疗水平。     

Surveillance and infection control in an intensive care unit.

OBJECTIVE: To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality. DESIGN: Prospective study. SETTING: A 2000-bed, university-affiliated hospital in Italy. PATIENTS: All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001. METHODS: The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility. INTERVENTIONS: Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified. RESULTS: Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P < .05). CONCLUSION: Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAls and mortality.     

小儿重症监护病房多重耐药菌分析与控制措施

目的分析重症监护病房中小儿多重耐药菌的情况,并总结有效的临床控制措施。方法选取该院在近期内收治的578例重症监护病房的患儿,对入选患儿进行多重耐药菌的检测分析,并总结有效的临床控制措施。结果本组578例患儿中,合计检出51例患儿发生了多重耐药菌的感染,占患儿总数的8.82%;检出的多重耐药菌中以肺炎克雷伯菌最多,占35.29%(18/51),其次依次为鲍曼不动杆菌27.45%(14/51)、耐甲氧西林凝固酶阴性葡萄球菌25.49%(13/51)、耐甲氧西林金黄色葡萄球菌11.76%(6/51)。结论重症监护病房中小儿患者发生多重耐药菌感染主要以肺炎克雷伯菌为主,引起小儿患者发生多重耐药菌感染的因素主要以抗生素药物的不合理应用为主,临床应加强监测并合理对患儿适时抗生素治疗,这样可以有效的降低多重耐药菌感染的发生率。     

某ICU耐亚胺培南铜绿假单胞菌感染现状调查

目的词查某院重症监护室（ICU）分离的铜绿假单胞菌耐亚胺培南药物的现状及治疗结果。方法以该ICU2004年全年经病原学证实的铜绿假单胞菌感染者为研究对象，药敏试验采用美国B-D全自动微生物检测系统完成，根据美国临床实验室标准化委员会标准判读结果。结果共检出57株菌，其中对亚胺培南敏感者33株（57．89％），耐药者24株（42．11％）。耐亚胺培南菌株中，耐药≥3类者占83．33％，显著高于亚胺培南敏感菌株的12．12％（X^2=28．906，P〈0．001）。57例患者，2例自动出院，47例治愈，3例病死（均为耐亚胺培南铜绿假单胞菌感染者）。结论ICU为耐亚胺培南铜绿假单胞菌感染高发病区，也是多重耐药菌株感染较多的病区，应重点监控。     

多种干预措施对ICU患者多重耐药菌感染的作用

正多重耐药菌(multidrug-resistant organism,MDRO)是医院重症监护病房(intensive care unit,ICU)患者医院感染的重要病原菌[1]。有效预防和控制MDRO在ICU的传播是医院感染管理的难题之一[2],许多学者对MDRO医院感染的预防与控制措施及其效果进行了研究,现综述如下。1流行病学世界卫生组织报道:欧洲联盟2007年报道指     

王霞,冉霞成

目的探讨多方位全程干预措施在重症监护室（ICU）感染控制中的应用效果。方法选取某院2010年6月ICU投入使用以来采用多方位全程护理干预的600例重症患者（观察组）及2010年6月前（ICU未投入使用,未采用多方位全程护理干预）的315例重症患者（对照组）为研究对象,比较两组的感染率、护理质量合格率、医患矛盾冲突发生率及患者满意率。结果观察组的感染率、护理质量合格率、医患矛盾冲突发生率及患者满意率分别为3.00%、91.17%、1.67%、93.00%,显著高于对照组的12.06%、74.92%、9.52%、74.92%（均P〈0.05）,即采用多方位全程护理干预的观察组护理效果明显优于对照组。结论多方位全程干预措施在ICU感染控制中的应用可有效降低感染率,提高医疗护理质量,确保患者住院安全,减少医疗纠纷。     

重症监护病房患者耳念珠菌感染的调查与防控

目的 调查某院重症医学科(ICU)耳念珠菌患者感染/定植及环境污染情况,评价医院感染防控措施的效果。方法 2022年6月某院ICU 1例长期住院患者血培养检出耳念珠菌,立即对该科住院患者不同体表部位及病区环境进行多次采样和细菌培养(频率为每间隔一周采样一次),并采用基质辅助激光解吸电离飞行时间质谱技术进行分析。对检出耳念珠菌的患者采取单间隔离、温水冲浴、洗必泰擦洗等措施,对病区环境采取擦洗、消毒等措施,采取主动筛查的方法评估防控措施效果。结果 第一次主动筛查ICU 14例在院患者,其中8例患者检出耳念珠菌9株;首次检出耳念珠菌前一周内转出ICU的3例患者,均未检出耳念珠菌。第二次主动筛查ICU 13例在院患者,其中2例患者检出耳念珠菌2株;第三次主动筛查ICU 8例在院患者,仅在1例患者的腹股沟和腋下检出耳念珠菌,余患者筛查均为阴性;第四、五次主动筛查均未再检出耳念珠菌。环境监测结果显示,第一次主动筛查采集80份环境标本,分别在地面、医疗设备检出耳念珠菌6株,第二、三次筛查均未检出耳念珠菌。经采取综合防控措施,14例在院患者仅1例发生耳念珠菌败血症医院感染,其余患者均确定为耳念珠菌定植...     

重症监护病房老年患者多药耐药菌的感染分布与来源分析

目的分析重症监护病房(ICU)老年患者多药耐药菌(MDROs)感染分布及来源,为老年患者制定针对性MDROs防控策略提供依据。方法收集江苏省人民医院2017年7月-2019年6月8个ICU的患者MDROs感染资料,分为老年患者(>65岁)和非老年患者(≤65岁),MDROs感染来源分为医院感染(本院转入和科室获得)和院外感染(外院转入和社区获得)。结果 ICU中老年患者共检出感染的MDROs 852株,非老年患者共检出感染的MDROs 1 045株。老年患者和非老年患者MDROs感染构成均以耐碳青霉烯类鲍氏不动杆菌(CRAB)和耐碳青霉烯类肠杆菌科(CRE)为主。两组患者MDROs感染部位前两位均为下呼吸道感染和血流感染,老年患者下呼吸道感染占比(86.74%)高于非老年患者(79.23%),差异有统计学意义(P<0.001)。两组患者MDROs感染来源院外感染比例(53.87%和55.89%)均高于医院感染(46.13%和44.11%)。8个ICU老年患者的CRE感染数量最多的前三位分别是综合ICU(33.92%)、老年ICU(26.53%)和神外ICU(9.51%)。ICU老年患者MDROs来源外院转入占23.24%,社区获得占30.63%,本院转入占6.92%,科室获得占39.20%。CRAB、CRPA及CRE感染来源在各ICU之间的差异均有统计学意义(P<0.001)。结论 ICU老年患者MDROs感染分布具有一定特殊性,感染来源在不同ICU也存在多样性,需根据其特点,采取针对性措施,实现精准化防控。     

内科重症监护病房铜绿假单胞菌医院感染同源性及临床特点

目的研究内科重症监护病房(MICU)铜绿假单胞菌(PA)医院感染的同源性及临床特点,以指导临床预防PA传播,提高治疗效果。方法对某院2014年1—12月MICU发生医院感染的25例患者分离的55株PA进行脉冲场凝胶电泳(PFGE)同源性分析及聚类分析,对其临床特点、耐药性及其传播特点进行分析。结果共调查25例患者,平均年龄为(69.62±2.13)岁,平均住院时间(49.34±3.18)d;在分离出PA之前,84.00%的患者应用广谱抗菌药物2周,76.00%的患者入住过MICU,52.00%的患者使用呼吸机辅助通气。55株PA主要以A、F、H、K、N、V、W型为主要的流行菌株;感染A型、F型、H型及K型菌株的患者在各自住院时间上均存在交叉;有4例患者不同时期分离菌株的PFGE图谱分析显示不同菌型;PA对头孢他啶(72.73%)、哌拉西林/他唑巴坦(70.91%)、亚胺培南(70.91%)耐药率高,对阿米卡星耐药率最低(25.45%)。结论医疗机构应加强抗菌药物管理,加强医院感染控制措施,防止多重耐药和泛耐药细菌在医院内的播散。     

Outbreak of Pseudomonas aeruginosa ventriculitis among patients in a neurosurgical intensive care unit.

OBJECTIVE: To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure. METHODS: Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997). A case-patient was any patient with P aeruginosa ventriculitis during the epidemic period. Pulsed-field gel electrophoresis (PFGE) was performed on all isolates. RESULTS: P aeruginosa was significantly more likely to be isolated from CSF per EVC placed in the epidemic than pre-epidemic (January 1-August 7, 1997) periods (8/61 [13%] vs 2/131 [1.5%], P=.002). During the epidemic period, ventriculitis was significantly more likely after EVC placement in the operating room than in other units (8/24 vs 0/22, P=.004). EVC placement technique differed for EVCs placed in the operating room (little hair was removed, preventing application of an occlusive dressing) versus other hospital units (more hair was removed, and an occlusive dressing was applied). Among patients who had operating room EVC placement, contact with one healthcare worker was statistically significant (7/13 vs 0/8, P=.02). Hand cultures of this worker were negative. All isolates had closely related PFGE patterns. CONCLUSIONS: These data suggest that a single healthcare worker may have contaminated EVC insertion sites, resulting in an outbreak of P aeruginosa ventriculitis. Affected patients were unlikely to have had an occlusive dressing at the EVC insertion site. Application of a sterile occlusive dressing may decrease the risk of ventriculitis in patients with EVCs.     

重症监护病房血管导管相关血流感染发病率及预防措施多中心调查

目的了解某市三级医院重症监护病房(ICU)中心静脉导管相关血流感染(CRBSI)预防与控制质量安全管理现状,探讨其对策。方法用自行设计的问卷,调查CRBSI防控及质量管理现状。结果8所医院ICU CRBSI发病率为4.81‰,例次发病率为5.02‰。6所(75.00%)医院具有预防CRBSI标准操作规程,2所(25.00%)医院有中心静脉导管(CVC)维护专用记录单,仅2所(25.00%)医院实施了最大无菌屏障和置管组合措施,无医院使用抗感染敷料和氯己定洗浴。结论该市三级医院ICU预防与控制CRBSI标准操作规程及落实控制措施方面存在很多问题,有待加强和改进。     

重症监护病房多重耐药菌感染患者疾病谱分析

目的 了解重症监护病房(ICU)多重耐药菌(MDRO)感染患者的感染现状及疾病谱分布情况,为MDRO感染防控提供依据。方法 分析某三甲医院2018年1月—2020年12月ICU住院患者资料,比较ICU感染MDRO者(病例组)、ICU非MDRO感染患者(对照组),以及非ICU感染MDRO者疾病谱等差异。结果 ICU MDRO感染患者总体构成呈上升趋势;感染患者以男性居多,其中大多数为老年人,MDRO感染患者较未感染患者死亡比例更高。直接入住ICU感染MDRO者在整个MDRO感染群体中占比最高。ICU MDRO感染患者检出菌株以鲍曼不动杆菌居首位,非ICU MDRO感染患者检出菌株以大肠埃希菌居首位;前两组患者的疾病谱相似,以呼吸系统疾病居第一位,其中又以肺部感染为主;ICU非MDRO感染患者疾病谱以高血压居首位,与感染患者存在差异。不同疾病的顺位随着年份增长也有不同程度的变化。结论 MDRO感染患者疾病谱复杂多样,应做到科学、精准、规范治疗,注意呼吸系统疾病的治疗,同时强化感染预防措施的落实。     

Molecular epidemiology of Pseudomonas aeruginosa in an intensive care unit.

Genotyping was used to analyse Pseudomonas aeruginosa isolates from sink drains and 15 intubated patients as part of a 3-month prospective study of strain transmission in a medical-surgical intensive care unit. Ninety percent of all washbasin drains were persistently contaminated with several P. aeruginosa genotypes. In 60% (9/15) of the patients, P. aeruginosa colonization or infection was hospital-acquired: P. aeruginosa strains isolated from these patients were present in hospital sinks or in other patients before their admission. Since all patients were immobile, personnel were the probable route of transmission of P. aeruginosa in the hospital. The mechanism of strain transmission from sinks to hands during hand washing was investigated in a children''s hospital. When P. aeruginosa was present at densities of > 10(5)/c.f.u. per ml in sink drains, hand washing resulted in hand contamination with P. aeruginosa via aerosol generation in the majority of experiments or P. aeruginosa was detected using an air sampler above the washing basin. High P. aeruginosa cfu were present at 4.30 h in the eight sinks (5.4 x 10(5)-7.0 x 10(10) c.f.u./ml), whereas at 13.00 h P. aeruginosa c.f.u. were significantly lower (3.1 x 10(2)-8.0 x 10(5) c.f.u./ml). These data reveal that the danger of bacterial contamination of hands during hand washing is highest in the morning. The identified transmission routes demand more effective hygienic measures in hospital settings particularly concerning personnel hands and sink drains.     

38例高龄铜绿假单胞菌肺部感染的临床分析

目的 探讨铜绿假单胞菌肺部感染的现状及对策.方法 回顾性分析本院2006年5月～2008年5月发生的38例高龄铜绿假单胞菌肺部感染的临床资料.结果 在本组高龄铜绿假单胞菌肺部感染中院内获得性肺炎占92.1%(35/38),抗生素药敏试验表明细菌耐药率高.死亡率达34.2%(13/38).易感因素有:高龄、免疫功能低下、住院时间长、机械通气、患有慢性阻塞性肺疾病、长期大量的经验性使用广谱抗生素.结论 铜绿假单胞菌肺部感染是医院获得性肺炎最常见的一种,多发生在有多种基础疾病的高龄患者,细菌耐药发生率高,病死率高.尽早做病原学检查,合理应用抗生素,免疫营养支持十分重要.