实施主动筛查防控重症监护病房多重耐药菌传播流行

目的对重症监护病房（ICU）住院患者采取主动筛查干预措施，早期发现多重耐药菌（MDRO）定植患者，并实施接触隔离措施，预防和控制MDRO交叉传播。 方法对2012年9月—2013年5月入住ICU的240例患者鼻前庭和直肠拭子进行培养筛查，并对耐甲氧西林金黄色葡萄球菌（MRSA）和产超广谱β 内酰胺酶（ESBLs）的大肠埃希菌、肺炎克雷伯菌定植患者实施接触隔离。收集主动筛查前后（2011年9月—2012年8月和2012年9月—2013年8月）ICU患者临床培养MDRO分离株并进行耐药性分析。结果240例患者中有56例鼻腔MRSA定植，定植率23.33%。其中入ICU时筛查MRSA已定植者22例，占39.29%；住ICU期间新增定植者34例，占60.71%。105例直肠拭子产ESBLs大肠埃希菌、肺炎克雷伯菌定植，定植率43.75%。其中入ICU时筛查已定植者72例，占68.57%；住ICU期间新增定植者33例，占31.43%。实施主动筛查前后ICU患者MDRO检出发病密度分别为28.56‰、13.71‰，差异有统计学意义［P＜0.05，RR及95%CI为2.08（1.582～2.743）］。结论ICU住院患者MDRO定植率较高，实施以主动筛查为基础的MDRO综合防控措施，可降低ICU MDRO传播流行。

Implementation of active screening for preventing and controlling the spread of multidrug resistant organisms in intensive care unit

ObjectiveTo implement active screening measures for patients in intensive care unit (ICU), early detect patients with multidrug resistant organism (MDRO) colonization, implement contact isolation measures, prevent and control MDRO cross transmission. MethodsThe nasal and rectal swabs of 240 patients who were admitted to ICU from September 2012 to May 2013 were performed bacterial culture, patients with colonization of methicillin resistant Staphylococcus aureus (MRSA) ,extended spectrum β lactamases(ESBLs) producing Escherichia coli, and ESBLs producing Klebsiella pneumoniae were conducted contact isolation. Clinically isolated MDROs from ICU patients in September 2011-August 2012 (before active screening) and September 2012-August 2013 (after active screening) were collected and performed antimicrobial resistance analysis. ResultsOf 240 patients, nasal swabs screening test showed that there were 56(23.33%) patients who were colonized with MRSA, including 22(39.29%) were colonized at the admission to ICU and 34(60.71%) during the ICU stay. Rectal swabs screening test showed that there were 105(43.75%) patients who were colonized with ESBLs producing Escherichia coli and Klebsiella pneumoniae, 72(68.57%) were colonized at the admission to ICU, and 33(31.43%) were colonized during the period of ICU stay. The incidence density of MDROs before and after implementing active screening were 28.56‰ and 13.71‰ respectively, difference was significant (P<0.05;RR,2.08［95%CI, 1.582-2.743］）.ConclusionMDRO colonization rate is high among ICU inpatients, implementation of comprehensive prevention and control measures against MDROs based on active screening can reduce the spread of MDROs in ICU.