CAJ | 학술논문

目的：了解某院外科重症监护室（SICU ）多重耐药菌（MDRO ）的定植情况及其危险因素，为临床主动筛查 MDRO提供依据。方法对2013年6月1日—8月31日入住该院SICU≥24 h 的患者进行主动筛查，检测患者耐甲氧西林金黄色葡萄球菌（MRSA）、产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌（ESBL＋E．coli／Kp）定植情况，并进行相关危险因素分析。结果入住SICU≤48 h的患者MRSA及ESBL＋E．coli／Kp检出率分别为11．00％、73．00％；入住SICU＞7 d者 MRSA 及 ESBL＋E．coli／Kp 新增检出率分别达16．67％、44．44％。入住SICU前住院时间＞7 d[OR95％ CI：4．48（1．21～16．65）]是患者入住 SICU 时检出 MRSA 的独立危险因素， APACHEⅡ评分≥16分[OR95％ CI：6．36（1．47～27．54）]是患者入住SICU＞48 h检出 MRSA的独立危险因素。结论入住SICU患者 MDRO 检出率高，随着住SICU 时间的延长，MDRO 的检出率不断上升。医院应开展主动筛查，及时发现 MDRO定植患者，通过实施有效的隔离控制措施，降低医院感染发生。
목적：료해모원외과중증감호실（SICU ）다중내약균（MDRO ）적정식정황급기위험인소，위림상주동사사 MDRO제공의거。방법대2013년6월1일—8월31일입주해원SICU≥24 h 적환자진행주동사사，검측환자내갑양서림금황색포도구균（MRSA）、산초엄보β-내선알매대장애희균화폐염극뢰백균（ESBL＋E．coli／Kp）정식정황，병진행상관위험인소분석。결과입주SICU≤48 h적환자MRSA급ESBL＋E．coli／Kp검출솔분별위11．00％、73．00％；입주SICU＞7 d자 MRSA 급 ESBL＋E．coli／Kp 신증검출솔분별체16．67％、44．44％。입주SICU전주원시간＞7 d[OR95％ CI：4．48（1．21～16．65）]시환자입주 SICU 시검출 MRSA 적독립위험인소， APACHEⅡ평분≥16분[OR95％ CI：6．36（1．47～27．54）]시환자입주SICU＞48 h검출 MRSA적독립위험인소。결론입주SICU환자 MDRO 검출솔고，수착주SICU 시간적연장，MDRO 적검출솔불단상승。의원응개전주동사사，급시발현 MDRO정식환자，통과실시유효적격리공제조시，강저의원감염발생。
Objective To investigate colonization status and risk factors of multidrug-resistant organisms (MDROs)in a surgical intensive care unit (SICU),and provide a basis for active clinical screening of MDROs. Methods From June 1,2013 to August 31,2013,patients who admitted to SICU≥24 hours were performed active screening,the colnization status of methicillin-resistant Staphylococcus aureus (MRSA)and extended-spectrumβ-lactamase-producing Escherichiacoli/Klebsiellapneumoniae (ESBL-E.coli/Kp)among patients were detected,re-lated risk factors were analyzed. Results When patients who admitted to SICU≤48 hours,the detection rate of MRSA and ESBL-E.coli/Kp was 1 1 .00% and 73 .00% respectively;when admitted to SICU>7 days,the increased detection rate of MRSA and ESBL-E.coli/Kp was 16.67% and 44.44% respectively. Patients stayed in hospital >7 days before admit-ting to SICU (OR95% CI:4.48 [1 .21-16.65 ])was an independent risk factor of carrying MRSA when admitting to SICU,APACHEⅡscore ≥16 (OR95% CI:6.36[1.47-27.54])was an independent risk factor of carrying MRSA 48 hours after admitting to SICU. Conclusion When patients admitted to SICU,the carrying rate of MDROs is high,isola-tion rate rises with prolonged length of SICU stay. Hospitals should carry out MDRO colonization screening proj ect among patients and implement effective isolation control measures to reduce the incidence of healthcare-associated infection.