MDRO检出患者再入院重复检出的综合风险评估

Comprehensive risk assessment for MDRO redetection in patients readmitted to hospital

    摘要
  • 摘要:
    目的  对多药耐药菌(MDRO)检出患者再入院重复检出开展综合风险评估，以期为这部分人群的MDRO防控提供依据和思路。
    方法  选择南京医科大学第一附属医院2022年检出的2 274株MDRO患者为研究对象，MDRO包括耐碳青霉烯类肺炎克雷伯菌(CRKP)、耐碳青霉烯类大肠埃希菌(CREC)、耐碳青霉烯类鲍曼不动杆菌(CRAB)、耐碳青霉烯类铜绿假单胞菌(CRPA)和耐甲氧西林金黄色葡萄球菌(MRSA)，评估其再入院后重复检出的风险因素和时间范围。
    结果  MDRO检出患者1年内再次入院重复检出的比例为8.88%(202/2 274)，其中排在前三位的分别为CRPA(15.96%)、CRKP(12.57%)和CREC(7.27%)，不同MDRO间差异有统计学意义(P＜0.001)；非首次住院MDRO检出患者中1年内再入院重复检出比例高于首次住院的患者(18.67% vs. 2.96%)，CRKP(21.01% vs. 7.63%)、CRAB(17.67% vs. 1.25%)、CRPA(25.53% vs. 4.19%)和MRSA(11.11% vs. 2.48%)在两组间的差异也均有统计学意义(P＜0.001)；不同科室片区MDRO检出患者1年内再次入院重复检出比例最高的前三位分别为老年医学科(36.75%)、内科(7.73%)和外科(5.65%)；不同感染类型MDRO检出患者1年内再入院重复检出比例，由高到低分别为社区感染(11.82%)、医院感染(6.70%)和定植(3.94%)，差异有统计学意义(P＜0.001)；MDRO检出患者再入院重复检出数随着出院时间的延长而逐步减少，主要集中在出院后1个月内(47.52%)和1~3个月(32.67%)；累积占比3个月内为80.20%，6个月内为92.08%。
    结论  MDRO检出患者再次入院具备导致MDRO院内传播的风险，其中有住院史、MDRO感染、老年医学科、MDRO患者出院后6个月内再入院为MDRO携带的高风险人群，应借助信息化功能进行重点防控。

     

    Abstract:
    OBJECTIVE  To carry out a comprehensive risk assessment of multiple drug resistant organisms (MDRO) detection in patients readmitted to hospital, to providing the basis and ideas for the prevention and control of MDRO in such population.
    METHODS  A total of 2 274 patients with MDRO carbapenem-resistant Klebsiella pneumoniae (CRKP), Escherichia coli(CREC), Acinetobacter Baumannii (CRAB), Pseudomonas Aeruginosa (CRPA), and methicillin-resistant Staphylococcus aureus (MRSA)detected in the First Affiliated Hospital of Nanjing Medical University in 2022 were selected for the study, risk factors and intervals of redetection after readmission were assessed.
    RESULTS  The proportion of patients with MDRO redetection after readmittance within 1 year was 8.88% (202/2 274), with CRPA (15.96%), CRKP (12.57%), and CREC (7.27%) ranking the top three; there were statistically significant differences among different MDROs redetective rates (P < 0.001); the proportion of MDRO redetection within 1 year among patients with repeated hospitalization was significantly higher than that in those with first-time hospitalization (18.67% vs. 2.96%), and the differences between the two groups were also statistically significant for CRKP (21.01% vs. 7.63%), CRAB (17.67% vs. 1.25%), CRPA (25.53% vs. 4.19%) and MRSA (11.11% vs. 2.48%) (P < 0.001). The top three departments of patients with MDRO redetection within 1 year were geriatric medicine (36.75%), internal medicine (7.73%) and surgery (5.65%); the main reinfection types in a descending order were community-acquired infections (11.82%), hospital-acquired infections (6.70%) and colonization (3.94%) with statistically significant differences (P < 0.001); the redetection rates of MDRO decreased gradually with the prolongation of discharge; the onset time mainly concentrated in 1 month (47.52%) and 1-3 months (32.67%) after discharge, the cumulative incidence of which was 80.20% in 3 months and 6 months was 92.08%.
    CONCLUSIONS  Readmission of MDRO-redetected patients might cause hospital-associated transmission. Those with history of hospitalization, MDRO infection, geriatric medicine and readmission of MDRO patients within 6 months after discharge are the high-risk population, which should be prevented and controlled with the help of information technology.

     

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