ICU患者呼吸道多药耐药菌定植及感染状况前瞻性调查研究

Prospective investigation of multi-drug resistant bacteria colonization and infection conditions of patients treated with respiratory tract in ICU

    摘要
  • 摘要: 目的 探讨重症监护室(ICU)患者呼吸道多药耐药菌定植及感染状况,为医院感染的预防控制提供参考。方法 选取2014年1月-2016年6月在医院ICU住院治疗100例患者,采集患者入ICU第1天、第7天时咽试子或人工气道吸痰标本共324份,进行病原菌培养,筛查耐超广谱β-内酰胺酶(ESBLs)大肠埃希菌、耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯类肺炎克雷伯菌(CRKP)、ESBLs肺炎克雷伯菌。结果 入ICU第1天分离出多药耐药菌78株,其中ESBLs大肠埃希菌57株、MRSA 14株、CRKP 5株、ESBLs肺炎克雷伯菌2株,分别占73.08%、17.95%、6.41%、2.56%,第7天分离出多药耐药菌112株,其中ESBLs大肠埃希菌72株、MRSA 21株、CRKP 11株、ESBLs肺炎克雷伯菌8株,分别占64.29%、18.75%、9.82%、7.14%;入ICU第1天分离ESBLs大肠埃希菌、MRSA、CRKP、ESBLs肺炎克雷伯菌感染率分别为63.16%、50.00%、20.00%、0,定植率分别为36.84%、50.00%、80.00%、100.00%,第7天分离ESBLs大肠埃希菌、MRSA、CRKP、ESBLs肺炎克雷伯菌感染率分别为79.17%、85.71%、81.82%、87.50%,定植率分别为20.83%、14.29%、18.18%、12.50%;入ICU第7天时患者呼吸道多药耐药菌感染率明显高于第1天时,比较差异有统计学意义(P<0.05)。结论 ICU患者呼吸道定植及感染的多药耐药菌主要是ESBLs大肠埃希菌,随着住院时间延长多药耐药菌感染率明显增加。

     

    Abstract: OBJECTIVE To discuss multi-drug resistant bacteria colonization and infection condition of patients treated with respiratory tract in ICU, so as to provide references for the prevention and control of nosocomial infections. METHODS A total of 100 patients hospitalized with ICU from Jan. 2014 to Jun. 2016 were selected. Totally 324 specimens of throat swab or artificial airway sputum suction on the 1st d and 7th d were collected. Pathogenic bacteria were cultured, and Escherichia coli and Klebsiella pneumonia producing extended spectrum β-lactamases(ESBLs), methicillin-resistant Staphylococcus aureus (MRSA),and carbapenem-resistant Klebsiella pneumoniae(CRKP)were screened. RESULTS Totally 78 strains of multi-drug resistant bacteria were isolated on the 1st d, including 57 strains of ESBLs E. coli, 14 strains of MRSA, 5 strains of CRKP, and 2 strains of ESBLs K. pneumonia, accounting for 73.08%, 17.95%,6.41% and 2.56%, respectively. Totally 112 strains of multi-resistant bacteria were isolated on the 7th d, including 72 strains of ESBLs E. coli, 21 strains of MRSA, 11 strains of CRKP, and 8 strains of ESBLs K. pneumonia, accounting for 64.29%, 18.75%,9.82% and 7.14%, respectively. The infection rates of ESBLs E. coli, MRSA, CRKP, ESBLs K. pneumonia were 63.16%, 50.00%,20.00% and 0 on the 1st d, the colonization rates were 36.84%, 50.00%,80.00% and 100.00% on the 1st d, and the infection rates were 79.17%, 85.71%,81.82% and 87.50% on the 7th d, colonization rates were 20.83%, 14.29%,18.18% and 12.50% on the 7th d. Multi-drug resistant bacteria infection rates on the 7th d were significantly higher than those on the 1st d (P<0.05). CONCLUSION ESBLs E. coli was the major multi-drug resistant bacteria which leads to colonization and infection in ICU patients. The multi-drug resistant bacteria infection rates significantly increase with the time extension of the hospitalization.

     

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