不同专业重症监护病房多重耐药菌医院感染特征

Characteristics of multidrug-resistant organism healthcare-associated infection in different specialized intensive care units

摘要:

目的 了解不同专业重症监护病房（ICU）连续5年多重耐药菌（MDRO）感染情况，为不同专业的ICU合理使用抗菌药物提供参考依据。 方法 回顾性研究2016年1月-2020年12月某三级甲等医院9个不同专业的ICU住院患者检出的MDRO资料，分析不同专业ICU MDRO检出率、发现率、感染部位以及细菌耐药率。 结果 2016-2020年不同专业ICU共监测住院患者30 030例，检出MDRO 2 744株，其中医院感染1 235株。5年间不同种类的MDRO检出率比较，差异有统计学意义（P < 0.05）；耐碳青霉烯类铜绿假单胞菌（CRPA）和耐碳青霉烯类肺炎克雷伯菌（CRKP）不同年度检出率比较，差异均有统计学意义（均P < 0.05），并有年度升高趋势。5年间MDRO感染发现率为3.86%，发现例次率为4.11%；不同专业间ICU不同年度和持续5年的MDRO感染发现例次率比较，差异均有统计学意义（均P < 0.05）；所有ICU不同年度MDRO感染发现例次率比较，差异无统计学意义（P>0.05）。MDRO感染部位居前3位分别为下呼吸道（578例次）、血液（240例次）、泌尿道（170例次）。综合ICU、心外ICU、神外ICU、急诊ICU检出的CRAB对庆大霉素、环丙沙星的耐药率比较，差异均有统计学意义（均P < 0.05）；CRPA对庆大霉素的耐药率比较，差异有统计学意义（均P < 0.05）。不同年度CRAB对头孢哌酮/舒巴坦的耐药率比较，以及CRPA对哌拉西林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率比较，差异均有统计学意义（均P < 0.05）。 结论 临床诊疗过程中，应根据不同专业ICU的MDRO感染特征指导感染防控措施，并合理使用抗菌药物。

Abstract:

Objective To understand the multidrug-resistant organism (MDRO) infection in different specialized intensive care units (ICUs) for 5 consecutive years, and provide reference basis for the rational use of antimicrobial agents in different specialized ICUs. Methods Data of MDROs isolated from inpatients in 9 different specialized ICUs in a tertiary first-class hospital between January 2016 and December 2020 were retrospectively studied, isolation rate, discovery rate, infection site and antimicrobial resistance rate of MDROs in different specia-lized ICUs were analyzed. Results From 2016 to 2020, 30 030 inpatients in different specialized ICUs were monitored, 2 744 strains of MDROs were isolated, including 1 235 strains of healthcare-associated infection (HAI) pathogens, there was significant difference in the isolation rates of different kinds of MDROs during 5 years (P < 0.05); there were significant differences in the isolation rates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbape-nem-resistant Klebsiella pneumoniae (CRKP) in different years (all P < 0.05), and there was an annual upward trend. Discovery rate of MDRO infection in 5 years was 3.86%, and case infection rate was 4.11%; there were significant difference in the case incidence of MDRO infection in different specialized ICUs in different years and 5 years (all P < 0.05); there was no significant difference in the case incidence of MDRO infection in all ICUs in different years (P>0.05). The top 3 sites of MDRO infection were lower respiratory tract (578 cases), blood (240 cases) and urinary tract (170 cases). Resistance rates of CRAB isolated from general ICU, cardiovascular surgery ICU, neurosurgery ICU and emergency ICU to gentamicin and ciprofloxacin were all significantly different (all P < 0.05), resistance rates of CRPA to gentamicin were significantly different (all P < 0.05). Resistance rates of CRAB to ce-foperazone/sulbactam and CRPA to piperacillin, piperacillin/tazobactam as well as cefo-perazone/sulbactam were all significantly different (all P < 0.05). Conclusion During the process of clinical diagnosis and treatment, infection prevention and control measures and rational use of antimicrobial agents should be guided according to the characte-ristics of MDRO infection in different specialized ICUs.