2018 年第 2 期 第 13 卷

主动筛查对重症监护病房内耐碳青霉烯类肠杆菌感染率的影响

作者：郭辅政朱凤雪李纾赵秀娟蒋丽蕾薛海岩

英文作者：

单位：100044北京大学人民医院重症医学科

英文单位：

关键词：耐碳青霉烯类肠杆菌科细菌；重症监护室；主动筛查；病原微生物检测；感染控制

英文关键词：

• 摘要：

• 目的    探讨主动筛查与常规病原微生物检测重症监护病房（ICU）高危易感患者耐碳青霉烯类肠杆菌科细菌（CRE）感染率的差异。方法    选取2016年4—9月北京大学人民医院ICU患者192例作为研究对象，完全随机分为2组，对照组96例进行常规病原微生物检测,观察组96例在常规病原微生物检测的同时进行主动CRE筛查,对CRE感染或定植患者及时实施接触隔离预防措施及其他感染控制措施，观察2组患者CRE筛查结果以及CRE感染和非感染者ICU入住时间和ICU 28 d病死率。结果    观察组的CRE检出率高于对照组［19.8%（19/96）比9.4%（9/96）］，差异有统计学意义（P=0.04）。经及时隔离和感染控制后，观察组CRE感染率为2.1%（2/96），低于对照组［9.4%（9/96）］，差异有统计学意义（P=0.03）。11例CRE感染患者住ICU时间长于181例非感染患者［18(7，27)d比4(2，15)d］，ICU内28 d病死率高于非感染患者［45.5%（5/11）比9.4%（17/181），差异均有统计学意义(均P<0.05)。结论    对ICU内CRE高危易感患者进行主动筛查，可早期发现定植或可疑感染患者，指导临床医师针对性实施接触隔离预防措施及其他感染控制措施，有利于控制CRE的院内传播及降低CRE感染率。

• Effect of active surveillance on carbapenem-resistant enterobactericeae infection rate in intensive care unit

  Guo Fuzheng, Zhu Fengxue, Li Shu, Zhao Xiujuan, Jiang Lilei, Xue Haiyan

  Intensive Care Unit, Peking University People′s Hospital, Beijing 100044, China

  Corresponding author： Zhu Fengxue, Email: fxzhu72@163.com

  【Abstract】Objective    To investigate the effects of active surveillance and routine pathogenic microorganism detection on carbapenem-resistant enterobactericeae（CRE） infection rate in intensive care unit（ICU）. Methods    Totally 192 ICU patients were enrolled from April to September 2016 in Peking University People′s Hospital, and they were randomly assigned to have routine pathogenic microorganism detection（control group, n＝96） and active surveillance of CRE（observation group, n＝96）. Contact isolation and infection control measures were implemented in patients who were detected of CRE infection or colonization. ICU stay time and 28 d fatality rate were analyzed between CRE infection and non-infection patients. Results    Detection rate of CRE in observation group was significantly higher than that in control group［19.8%（19/96） vs 9.4%（9/96）］（P=0.04）. After contact isolation and infection control, infection rate of CRE in observation group was significantly lower than that in control group［2.1%（2/96） vs 9.4%（9/96）］（P=0.03）. ICU stay time of 11 CRE infection patients was significantly longer, and 28 d fatality rate was significantly higher than those of 181 non-infection patients［18(7,27)d vs 4(2,15)d, 45.5%（5/11） vs 9.4%（17/181）］(P<0.05). Conclusion    Active surveillance in susceptible patients can find CRE carriers in early time and help to reduce the prevalence of CRE infection.

  【Key words】Carbapenem-resistant enterobactericeae;Intensive care unit;Active surveillance;Pathogenic microorganism detection;Infection control

  【Fund program】National Natural Science Foundation of China(81641089)