儿童医院重点部门耐碳青霉烯类革兰阴性杆菌主动筛查结合集中安置干预效果评价

目的 对耐碳青霉烯类革兰阴性杆菌（CR-GNB）进行主动筛查,结合筛查结果对患者进行集中安置,评价干预措施的效果,为CR-GNB医院感染防控提供科学依据。 方法 选取2017年1月—2018年12月入住某儿科医院重点部门[新生儿、新生儿重症监护病房（NICU）、儿童重症监护病房（PICU）、血液科]患者为研究对象,并对所有患者进行医院感染实时监测。2017年对住院患者入院后48 h及住院期间每周进行一次CR-GNB主动筛查（咽拭子和肛拭子）,2018年1月开始对主动筛查及临床送检CR-GNB阳性患者开展集中安置措施,比较CR-GNB主动筛查率和定植率、集中安置率以及医院感染率的变化。 结果 2018年重点部门咽拭子和肛试子CR-GNB主动筛查率较2017年增加（P < 0.05）。新生儿室集中安置率最高（97.8%）,其次为NICU（88.9%）,PICU集中安置率最低（47.7%）。2018年重点部门CR-GNB定植率在住院3、7 d后呈下降趋势（P < 0.05）。2018年CR-GNB医院感染率较2017年有所下降（P < 0.05）,其中新生儿室和NICU患者耐碳青霉烯类肠杆菌目细菌（CRE）医院感染率下降明显,PICU患者耐碳青霉烯类鲍曼不动杆菌（CRAB）和耐碳青霉烯铜绿假单胞菌（CRPA）医院感染率下降明显。CR-GNB主动筛查定植菌和CR-GNB医院感染病原菌均以耐碳青霉烯类肺炎克雷伯菌（CRKP）为主（44.0% VS 51.7%）。 结论 CR-GNB主动筛查结合患者集中安置干预措施能够降低CR-GNB定植率,并有效降低CR-GNB医院感染率。

Efficacy of active screening on carbapenem-resistant Gram-negative bacillus combined with centralized resettlement intervention in key departments of a pediatric hospital

Objective To perform active screening on carbapenem-resistant Gram-negative bacilli (CR-GNB), carry out centralized resettlement for patients according to the screening results, evaluate the efficacy of intervention measures, and provide scientific basis for the prevention and control of healthcare-associated infection(HAI) due to CR-GNB. Methods From January 2017 to December 2018, patients who were admitted to key departments of a pediatric hospital (neonatal room, neonatal intensive care unit [NICU], pediatric intensive care unit [PICU], department of hematology) were selected as the research objects, all patients were performed HAI real-time monitoring. In 2017, active screening on CR-GNB (throat swab and anal swab) was performed for hospitalized patients 48 hours after admission and once a week during hospitalization. From January 2018, centralized resettlement measures were carried out for patients with positive CR-GNB in active screening and clinically delivered specimen detection, changes of active screening rate and colonization rate of CR-GNB as well as centralized resettlement rate and HAI rate were compared. Results Active screening rates of throat swab and anal swab in 2018 was higher than those in 2017 (P < 0.05). The highest centralized resettlement rate was in neonatal room (97.8%), followed by NICU (88.9%), PICU was the lowest (47.7%). In 2018, colonization rate of CR-GNB in key departments showed a downward trend after 3 and 7 days of hospitalization (P < 0.05). HAI rate of CR-GNB in 2018 decreased compared with that in 2017 (P < 0.05), carbapenem-resistant Enterobacterales HAI rate in neonatal room and NICU decreased significantly, HAI rates of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aegurinosa (CRPA) in patients in PICU decreased significantly. Carbapenem-resistant Klebsiella pneumoniae (CRKP) was the main pathogen in active screening of colonized bacteria and pathogens of CR-GNB HAI (44.0% vs 51.7%). Conclusion Active screening of CR-GNB combined with centralized resettlement intervention for patients can reduce the colonization rate of CR-GNB and effectively reduce HAI rate.