ICU多重耐药菌感染分布与来源研究
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摘要
目的分析重症监护病房(Intensive Care Unit,ICU)多药耐药菌(Multidrug-resistant Organisms,MDRO)感染分布及来源,为制定更有效的MDRO防控方案提供依据。方法回顾性调查某大型三甲医院2017年7月-2018年6月期间,全院8个ICU中MDRO感染情况,依据来源将8个ICU的MDRO分为院外感染(外院转入、社区获得)和院内感染(本院转入、科室获得)两大类型4个组别进行分析研究。结果感染的MDRO中以CRAB(64.8%)和CRE(20.09%)为主;MDRO检出率MRSA 49.75%、CRAB 90.47%、CRPA 55.06%、CRE40.46%均高于2017年全国细菌耐药监测网数据;MDRO感染部位分布前三位分别为下呼吸道感染85.04%、血流感染4.69%和手术部位感染3.79%;MDRO院外感染和院内感染分别为50.89%和49.11%,其中MRSA、CRAB、CRPA、CRE的院外感染比例分别为47.36%、54.04%、58.97%、38.33%,而科室获得的MDRO感染来源分别为43.86%、40.69%、37.18%、52.78%;综合性ICU与专科性ICU病房CRAB感染在社区获得、本院转入和科室获得等来源上差异有统计学意义(P<0.05)。结论 ICU超过一半的MDRO感染由外院转入或社区获得,应加强对MDRO来源的识别,有针对性地采取更为有效的精准化感染防控措施。
OBJECTIVE To analyze the distribution and source of multiple drug-resistant organisms in the Intensive Care Unit,ICU,to provide the basis for a more effective multi-drug-resistant bacterial control program.METHODS A retrospective investigation has been conducted on the MDRO infection of multi-drug resistant microorganisms(MDROs)in 8 ICUs in a large-scale tertiary class-A hospital from Jul.2017 to Jun.2018.According to the source,the MDROs in 8 ICUs were divided into 4 groups,namely,out-of-hospital infection(intra-hospital transfer,community acquisition)and in-hospital infection(in-hospital transfer,department acquisition)for analysis and study.RESULTS CRAB(64.8%)and CRE(20.09%)were the majority of the infected MDROs.MRSA(49.75%),CRAB(90.47%),CRPA(55.06%)and CRE(40.46%)were all higher than the data of 2017 national bacterial resistance monitoring network.The top three MDRO infection sites were lower respiratory tract infection(85.04%),bloodstream infection(4.69%)and surgical site infection(3.79%).The out-of-hospital and in-hospital infection rates of MDRO were 50.89% and 49.11%,respectively.The out-of-hospital infection rates of MRSA,CRAB,CRAB,CRPA and CRE were 47.36%,54.04%,58.97% and 38.33%,respectively.The source of MDRO infection obtained by the department was 43.86%,40.69%,37.18%and 52.78%,respectively.There was a significant difference between comprehensive ICU and specialized ICU wards in CRAB infection of community acquisition,hospital transfer,department acquisition and other sources(P<0.5).CONCLUSION More than half of the MDROs infections in the ICUs are transfered outside the hospital or community-acquired.We should strengthen the identification of the MDRO source and take more effective and precise infection prevention and control measures.
OBJECTIVE To analyze the distribution and source of multiple drug-resistant organisms in the Intensive Care Unit,ICU,to provide the basis for a more effective multi-drug-resistant bacterial control program.METHODS A retrospective investigation has been conducted on the MDRO infection of multi-drug resistant microorganisms(MDROs)in 8 ICUs in a large-scale tertiary class-A hospital from Jul.2017 to Jun.2018.According to the source,the MDROs in 8 ICUs were divided into 4 groups,namely,out-of-hospital infection(intra-hospital transfer,community acquisition)and in-hospital infection(in-hospital transfer,department acquisition)for analysis and study.RESULTS CRAB(64.8%)and CRE(20.09%)were the majority of the infected MDROs.MRSA(49.75%),CRAB(90.47%),CRPA(55.06%)and CRE(40.46%)were all higher than the data of 2017 national bacterial resistance monitoring network.The top three MDRO infection sites were lower respiratory tract infection(85.04%),bloodstream infection(4.69%)and surgical site infection(3.79%).The out-of-hospital and in-hospital infection rates of MDRO were 50.89% and 49.11%,respectively.The out-of-hospital infection rates of MRSA,CRAB,CRAB,CRPA and CRE were 47.36%,54.04%,58.97% and 38.33%,respectively.The source of MDRO infection obtained by the department was 43.86%,40.69%,37.18%and 52.78%,respectively.There was a significant difference between comprehensive ICU and specialized ICU wards in CRAB infection of community acquisition,hospital transfer,department acquisition and other sources(P<0.5).CONCLUSION More than half of the MDROs infections in the ICUs are transfered outside the hospital or community-acquired.We should strengthen the identification of the MDRO source and take more effective and precise infection prevention and control measures.
引文
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[22]张莹,龚瑞娥,刘珍如,等.677例多药耐药菌医院感染病例分析[J].中华医院感染学杂志,2017,27(18):4118-4122.
[23]Chittawatanarat K,Jaipakdee W,Chotirosniramit N,et al.Microbiology,resistance patterns,and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit[J].Infect Drug Resist,2014,7:203-210.
[2]Russotto V,Cortegiani A,Graziano G,et al.Bloodstream infections in intensive care unit patients:distribution and antibiotic resistance of bacteria[J].Infect Drug Resist,2015,8:287-296.
[3]陈瑜,王春英,陈琳,房君.多学科协作模式防控ICU多重耐药菌感染[J].中华医院感染学杂志,2018,28(18):2839-2842.
[4]Cassone M,Mody L.Colonization with multidrug-resistant organisms in nursing homes:scope,importance,and management[J].Curr Geriatr Rep,2015,4(1):87-95.
[5]Davies J.Origins and evolution of antibiotic resistance[J].Microbiologia,1996,12(1):9-16.
[6]Hidron AI,Edwards JR,Patel J,et al.Antimicrobial-resistant pathogens associated with healthcare-associated infections:annual summary of data reported to the national healthcare safety network at the Centers for Disease Control and Prevention,2006-2007[J].Infect Control Hosp Epidemiol,2008,29(11):996-1011.
[7]Vincent JL,Sakr Y,Sprung CL,et al.Sepsis in European intensive care units:results of the SOAP study[J].Crit Care Med,2006,34(2):344-353.
[8]Maragakis LL.Recognition and prevention of multidrug-resistant gram-negative bacteria in the intensive care unit[J].Crit Care Med,2010,38(8Suppl):S345-S351.
[9]Peleg AY,Hooper DC.Hospital-acquired infections due to gram-negative bacteria[J].N Engl J Med,2010,362:1804-1813.
[10]Arias CA,Murray BE.Antibiotic-resistant bugs in the 21st century-a clinical super-challenge[J].N Engl J Med,2009,360(5):439-443.
[11]周旋,杜贵琴,李雅君,等.ICU和非ICU病房多重耐药菌检出及耐药性差异[J].中国感染控制杂志,2018,17(3):219-223.
[12]Vincent JL,Marshall JC,Amendys-Silva SA,et al.Assessment of the worldwide burden of critical illness:the Intensive Care Over Nations(ICON)audit[J].Lancet Respir Med,2014,2(5):380-386.
[13](CLSI)Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].Twentyseventh informational supplement,2017.
[14]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[15]Magiorakos AP,Srinivasan A,Carey RB,et al.Multidrugresistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[16]Russotto V,Cortegiani A,Fasciana T,et al.What healthcare workers should Know about environmental bacterial contamination in the intensive care unit[J].Biomed Res Int,2017,2017:6905450.
[17]李福琴,杨阳,刘彩红,等.ICU多药耐药菌感染现状与危险因素分析[J].中华医院感染学杂志,2016,26(4):783-785.
[18]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[19]崔从先,李奇峰,童惠林,等.重症医学科住院患者多药耐药菌感染的临床分析及耐药性监测[J].中华医院感染学杂志,2017,27(11):2430-2433.
[20]全国细菌耐药监测网(CARSS).2017年全国细菌耐药监测报告[OL].http://www.carss.cn/Report/Details?aId=552,2018-11-30/2018-12-31.
[21]Zilahi G,Artigas A,Martin-Loeches I.What's new in multidrug-resistant pathogens in the ICU?[J].Ann Intensive Care,2016,6(1):96.
[22]张莹,龚瑞娥,刘珍如,等.677例多药耐药菌医院感染病例分析[J].中华医院感染学杂志,2017,27(18):4118-4122.
[23]Chittawatanarat K,Jaipakdee W,Chotirosniramit N,et al.Microbiology,resistance patterns,and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit[J].Infect Drug Resist,2014,7:203-210.