ICU患者MRSA定植与感染的危险因素研究

目的比较重症监护室(ICU)、呼吸内科监护室(RICU)和神经外科监护室(NSICU)耐甲氧西林金黄色葡萄球菌(MRSA)定植与感染状况,探讨患者MRSA定植/感染的危险因素。方法采用前瞻性研究方法,连续收集2013年5月1日—7月31日入住某院3个ICU患者的临床资料,采集患者(医护人员)鼻拭子及其周围环境标本进行MRSA检测。结果 197例患者,检出MRSA22株,MRSA定植率为11.17%;ICU、RICU和NSICU定植率分别为4.00%、11.90%和15.87%,差别无统计学意义(χ2=4.04,P=0.133)。患者临床标本MRSA检出率为2.03%(4/197),医护人员MRSA鼻前庭定植率为1.72%(2/116)。MRSA定植患者周围环境中MRSA检出率为22.73%(5/22),高于非定植患者4.00%(7/175)(χ2=8.93,P=0.003)。多因素logistic回归分析结果显示,年龄≥60岁、侵入性操作、住ICU时间长和近期使用抗菌药物是MRSA定植/感染的独立危险因素。结论临床应主动对入住ICU的患者进行MRSA定植筛查,采取有效措施,防止MRSA在医院环境与患者间的双向传播;同时,尽量避免使用侵入性操作,减少患者住院日和合理使用抗菌药物,减少ICU患者MRSA定植与感染的发生。

Risk factors for colonization/infection of methicillin resistant Staphylococcus aureus in intensive care unit patients

ObjectiveTo compare the colonization/infection of methicillin resistant Staphylococcus aureus (MRSA) in patients in intensive care unit (ICU), respiratory ICU (RICU) and neurosurgical ICU（NSICU）, so as to find out the risk factors for MRSA colonization/infection in patients. MethodsA prospective method was used for this study, data of all patients admitted to three ICUs between May 1 and July 31, 2013 were collected, specimens of nasal swabs of patients and health care workers (HCWs), as well as specimens of patients’ surroundings were taken and performed MRSA detection.ResultsThe average colonization rate of MRSA in 197 patients at  three ICUs was 11.17%, 22 MRSA strains were isolated, the colonization rate in ICU, RICU and NSICU patients was 4.00%, 11.90% and 15.87% respectively, no significant difference was found among different ICU groups (χ2=4.04, P=0.133). The detection rate of MRSA from patients was 2.03% （4/197）, colonization rate of MRSA in  HCWs’ nasal vestibule was 1.72%（2/116）. Detection rate of MRSA from surroundings of patients with MRSA colonization was higher than that  without MRSA colonization (22.73%［5/22］ vs 4.00%［7/175］,χ2=8.93， P=0.003）. Multivariate logistic regression analysis indicated that patients aged ≥60 years, invasive procedures, long length of ICU stay,and recent antimicrobial use were independent  risk factors for MRSA colonization/infection.ConclusionPatients in ICU should be screened for MRSA colonization, effective measures should be taken to avoid MRSA transmission between hospital and patients; invasive procedures should be minimized, length of ICU stay should be shortened, antimicrobial agents should be used rationally, so as to reduce MRSA colonization and infection in ICU patients.