中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
8期
667-671
,共5页
黄絮%李刚%易丽%李敏%王静
黃絮%李剛%易麗%李敏%王靜
황서%리강%역려%리민%왕정
重症医学科%重症加强治疗病房%多重耐药%耐甲氧西林金黄色葡萄球菌%产超广谱β内酰胺酶%定植
重癥醫學科%重癥加彊治療病房%多重耐藥%耐甲氧西林金黃色葡萄毬菌%產超廣譜β內酰胺酶%定植
중증의학과%중증가강치료병방%다중내약%내갑양서림금황색포도구균%산초엄보β내선알매%정식
Department of critical care medicine%Intensivecareunit%Multipledrugresistance%Methicillin-resistantStaphylococcus aureus%Extended-spectrumβ-lactamase%Colonization
目的：调查重症加强治疗病房（ICU）中多重耐药菌（MDROs）定植情况及相关危险因素，为MDROs定植的防治提供临床依据。方法采用单中心前瞻性观察性研究，自2008年6月至2014年12月对北京中日友好医院所有入住ICU超过24 h的患者进行鼻前庭拭子和肛拭子采样，并进行相关培养和药敏试验，同时填写病例调查表。采用单因素方差分析筛选出MDROs定植的危险因素；再将P＜0.05的危险因素进行logistic多元回归分析，筛选出MDROs定植的独立危险因素。结果1672例有效患者入组。入ICU时有MDROs定植的患者为604例（36.12%），其中耐甲氧西林金黄色葡萄球菌（MRSA）62例（3.71%），产超广谱β内酰胺酶（ESBL）的肠杆菌529例（31.64%），多重耐药鲍曼不动杆菌（MDR-AB）7例（0.42%），多重耐药铜绿假单胞菌（MDR-PA）6例（0.36%）。1068例入ICU时未发生MDROs定植的患者中ICU期间新发MDROs定植197例（18.45%），其中MRSA 24例（1.44%），产ESBL的肠杆菌118例（7.06%），MDR-AB 50例（2.99%），MDR-PA 5例（0.30%）。多因素logistic回归分析显示，入ICU时MDROs定植的独立危险因素包括：入ICU前使用抗菌药物＞2种〔优势比（OR）＝2.352，95%可信区间（95%CI）＝1.847～4.464，P＝0.002〕，入ICU前3个月内使用广谱抗菌药物（OR＝2.862，95%CI＝1.458～5.631，P＝0.014）、入ICU前抗菌药物使用时间（OR＝1.781，95%CI＝1.152～3.413，P＝0.003）和入ICU前住院时间＞9 d（OR＝1.766，95%CI＝1.235～3.986，P＝0.021）。结论本院ICU MDROs定植率较高，以产ESBL的肠杆菌为主，ICU获得性MDROs定植尤其是鲍曼不动杆菌的定植也值得重视。对MDROs定植患者的高危因素分析有助于早期发现高危患者和进行相应的主动筛查，并对预防耐药菌定植感染和限制广谱抗菌药物的使用有指导意义。
目的：調查重癥加彊治療病房（ICU）中多重耐藥菌（MDROs）定植情況及相關危險因素，為MDROs定植的防治提供臨床依據。方法採用單中心前瞻性觀察性研究，自2008年6月至2014年12月對北京中日友好醫院所有入住ICU超過24 h的患者進行鼻前庭拭子和肛拭子採樣，併進行相關培養和藥敏試驗，同時填寫病例調查錶。採用單因素方差分析篩選齣MDROs定植的危險因素；再將P＜0.05的危險因素進行logistic多元迴歸分析，篩選齣MDROs定植的獨立危險因素。結果1672例有效患者入組。入ICU時有MDROs定植的患者為604例（36.12%），其中耐甲氧西林金黃色葡萄毬菌（MRSA）62例（3.71%），產超廣譜β內酰胺酶（ESBL）的腸桿菌529例（31.64%），多重耐藥鮑曼不動桿菌（MDR-AB）7例（0.42%），多重耐藥銅綠假單胞菌（MDR-PA）6例（0.36%）。1068例入ICU時未髮生MDROs定植的患者中ICU期間新髮MDROs定植197例（18.45%），其中MRSA 24例（1.44%），產ESBL的腸桿菌118例（7.06%），MDR-AB 50例（2.99%），MDR-PA 5例（0.30%）。多因素logistic迴歸分析顯示，入ICU時MDROs定植的獨立危險因素包括：入ICU前使用抗菌藥物＞2種〔優勢比（OR）＝2.352，95%可信區間（95%CI）＝1.847～4.464，P＝0.002〕，入ICU前3箇月內使用廣譜抗菌藥物（OR＝2.862，95%CI＝1.458～5.631，P＝0.014）、入ICU前抗菌藥物使用時間（OR＝1.781，95%CI＝1.152～3.413，P＝0.003）和入ICU前住院時間＞9 d（OR＝1.766，95%CI＝1.235～3.986，P＝0.021）。結論本院ICU MDROs定植率較高，以產ESBL的腸桿菌為主，ICU穫得性MDROs定植尤其是鮑曼不動桿菌的定植也值得重視。對MDROs定植患者的高危因素分析有助于早期髮現高危患者和進行相應的主動篩查，併對預防耐藥菌定植感染和限製廣譜抗菌藥物的使用有指導意義。
목적：조사중증가강치료병방（ICU）중다중내약균（MDROs）정식정황급상관위험인소，위MDROs정식적방치제공림상의거。방법채용단중심전첨성관찰성연구，자2008년6월지2014년12월대북경중일우호의원소유입주ICU초과24 h적환자진행비전정식자화항식자채양，병진행상관배양화약민시험，동시전사병례조사표。채용단인소방차분석사선출MDROs정식적위험인소；재장P＜0.05적위험인소진행logistic다원회귀분석，사선출MDROs정식적독립위험인소。결과1672례유효환자입조。입ICU시유MDROs정식적환자위604례（36.12%），기중내갑양서림금황색포도구균（MRSA）62례（3.71%），산초엄보β내선알매（ESBL）적장간균529례（31.64%），다중내약포만불동간균（MDR-AB）7례（0.42%），다중내약동록가단포균（MDR-PA）6례（0.36%）。1068례입ICU시미발생MDROs정식적환자중ICU기간신발MDROs정식197례（18.45%），기중MRSA 24례（1.44%），산ESBL적장간균118례（7.06%），MDR-AB 50례（2.99%），MDR-PA 5례（0.30%）。다인소logistic회귀분석현시，입ICU시MDROs정식적독립위험인소포괄：입ICU전사용항균약물＞2충〔우세비（OR）＝2.352，95%가신구간（95%CI）＝1.847～4.464，P＝0.002〕，입ICU전3개월내사용엄보항균약물（OR＝2.862，95%CI＝1.458～5.631，P＝0.014）、입ICU전항균약물사용시간（OR＝1.781，95%CI＝1.152～3.413，P＝0.003）화입ICU전주원시간＞9 d（OR＝1.766，95%CI＝1.235～3.986，P＝0.021）。결론본원ICU MDROs정식솔교고，이산ESBL적장간균위주，ICU획득성MDROs정식우기시포만불동간균적정식야치득중시。대MDROs정식환자적고위인소분석유조우조기발현고위환자화진행상응적주동사사，병대예방내약균정식감염화한제엄보항균약물적사용유지도의의。
ObjectiveTo screen the colonization of multidrug resistant organisms (MDROs) and determine their risk factors in intensive care unit (ICU), so as to provide the basis of prophylaxis and treatment of MDROs colonization.Methods A prospective single-center study was conducted in ICU of China-Japan Friendship Hospital from June 2008 to December 2014. The nostril and anal swabs for each patient who stayed in ICU over 24 hours were collected. Each specimen was cultured and tested for drug sensitivity. Clinical findings and relative risk factors were collected. The risk factors of MDROs colonization were analyzed with univariate analysis. The independent risk factor was selected from the risk factors withP< 0.05 with logistic regression analysis to analyze the related factors of MDROs colonization in ICU.Results 1 672 patients were enrolled. At ICU admission, MDROs colonization was present in 604 cases (36.12%), of whom 62 cases (3.71%) were found to be colonized with methicillin-resistantStaphylococcus aureus (MRSA), 529 (31.64%) were colonized with extended-spectrumβ-lactamase (ESBL) enterobacteria, 7 (0.42%) were colonized with multidrug resistantAcinetobacter baumannii (MDR-AB), and 6 (0.36%) were colonized with multidrug resistantPseudomonas aeruginosa (MDR-PA). ICU acquired MDROs colonization were 197/1 068 (18.45%), among whom 24 patients (1.44%) were colonized with MRSA, 118 (7.06%) were colonized with ESBL enterobacteria, 50 (2.99%) were colonized with MDR-AB, and 5 (0.30%) were colonized with MDR-PA. By multivariable analysis, prior administration of more than two kinds of antibiotics [odds ratio (OR) = 2.352, 95% confidence interval (95%CI)=1.847 - 4.464,P = 0.002], prior use of broad spectrum antibiotics within 3 months (OR = 2.862, 95%CI = 1.458-5.631,P = 0.014), duration of prior antibiotic administration (OR = 1.781, 95%CI = 1.152 - 3.413,P = 0.003) and hospitalization days prior to ICU admission> 9 days (OR = 1.766, 95%CI = 1.235 - 3.986,P = 0.021) were independent risk factors of MDROs colonization on admission to ICU.ConclusionsHigh prevalence of MDROs colonization in ICU patients was found in our hospital, and ESBL enterobacteria was the predominant bacteria. ICU acquired MDROs colonization is also worth considering, especially for MDR-AB. Identification of risk factors for MDROs colonization may help identify and screen patients with high risk, and it is also instructive in prophylaxis of MDROs colonization/infection and restriction of the use of broad spectrum antibiotics.
