CAJ | 학술논문

目的：比较重症监护室（ICU）、呼吸内科监护室（RICU）和神经外科监护室（NSICU）耐甲氧西林金黄色葡萄球菌（MRSA）定植与感染状况，探讨患者 MRSA 定植／感染的危险因素。方法采用前瞻性研究方法，连续收集2013年5月1日—7月31日入住某院3个 ICU 患者的临床资料，采集患者（医护人员）鼻拭子及其周围环境标本进行 MRSA 检测。结果197例患者，检出 MRSA 22株，MRSA 定植率为11．17％；ICU、RICU 和 NSICU 定植率分别为4．00％、11．90％和15．87％，差别无统计学意义（χ2＝4．04，P ＝0．133）。患者临床标本 MRSA 检出率为2．03％（4／197），医护人员 MRSA 鼻前庭定植率为1．72％（2／116）。MRSA 定植患者周围环境中 MRSA 检出率为22．73％（5／22），高于非定植患者4．00％（7／175）（χ2＝8．93，P ＝0．003）。多因素 logistic 回归分析结果显示，年龄≥60岁、侵入性操作、住 ICU 时间长和近期使用抗菌药物是 MRSA 定植／感染的独立危险因素。结论临床应主动对入住 ICU 的患者进行 MRSA 定植筛查，采取有效措施，防止 MRSA 在医院环境与患者间的双向传播；同时，尽量避免使用侵入性操作，减少患者住院日和合理使用抗菌药物，减少 ICU 患者 MRSA 定植与感染的发生。
목적：비교중증감호실（ICU）、호흡내과감호실（RICU）화신경외과감호실（NSICU）내갑양서림금황색포도구균（MRSA）정식여감염상황，탐토환자 MRSA 정식／감염적위험인소。방법채용전첨성연구방법，련속수집2013년5월1일—7월31일입주모원3개 ICU 환자적림상자료，채집환자（의호인원）비식자급기주위배경표본진행 MRSA 검측。결과197례환자，검출 MRSA 22주，MRSA 정식솔위11．17％；ICU、RICU 화 NSICU 정식솔분별위4．00％、11．90％화15．87％，차별무통계학의의（χ2＝4．04，P ＝0．133）。환자림상표본 MRSA 검출솔위2．03％（4／197），의호인원 MRSA 비전정정식솔위1．72％（2／116）。MRSA 정식환자주위배경중 MRSA 검출솔위22．73％（5／22），고우비정식환자4．00％（7／175）（χ2＝8．93，P ＝0．003）。다인소 logistic 회귀분석결과현시，년령≥60세、침입성조작、주 ICU 시간장화근기사용항균약물시 MRSA 정식／감염적독립위험인소。결론림상응주동대입주 ICU 적환자진행 MRSA 정식사사，채취유효조시，방지 MRSA 재의원배경여환자간적쌍향전파；동시，진량피면사용침입성조작，감소환자주원일화합리사용항균약물，감소 ICU 환자 MRSA 정식여감염적발생。
Objective To compare the colonization/infection of methicillin-resistant Staphylococcus aureus (MR-SA)in patients in intensive care unit (ICU),respiratory ICU (RICU)and neurosurgical ICU(NSICU),so as to find out the risk factors for MRSA colonization/infection in patients.Methods A prospective method was used for this study,data of all patients admitted to three ICUs between May 1 and July 31,2013 were collected,specimens of nasal swabs of patients and health care workers (HCWs),as well as specimens of patients’surroundings were taken and per-formed MRSA detection.Results The average colonization rate of MRSA in 197 patients at three ICUs was 11.17%,22 MRSA strains were isolated,the colonization rate in ICU,RICU and NSICU patients was 4.00%,11.90% and 15.87%respectively,no significant difference was found among different ICU groups (χ2 =4.04,P =0.133).The detection rate of MRSA from patients was 2.03% (4/197),colonization rate of MRSA in HCWs’nasal vestibule was 1.72%(2/116).De-tection rate of MRSA from surroundings of patients with MRSA colonization was higher than that without MRSA coloniza-tion (22.73%[5/22]vs 4.00%[7/175],χ2 =8.93,P =0.003).Multivariate logistic regression analysis indicated that pa-tients aged ≥60 years,invasive procedures,long length of ICU stay,and recent antimicrobial use were independent risk factors for MRSA colonization/infection.Conclusion Patients in ICU should be screened for MRSA colonization,ef-fective measures should be taken to avoid MRSA transmission between hospital and patients;invasive procedures should be minimized,length of ICU stay should be shortened,antimicrobial agents should be used rationally,so as <br> to reduce MRSA colonization and infection in ICU patients.