西城区区属医院入院患者多重耐药菌快速筛查

发布时间：2018-07-23 18:54

【摘要】：目的:了解西城区区属医院入院患者多重耐药菌定植/感染情况及危险因素。方法:本研究为前瞻性队列研究。根据患者来源,将入院患者分为研究组(三甲医院转入)及对照组(社区直接入院),收集2014年6月至2015年9月西城区区属十家医院新入院患者鼻拭子和(或)肛拭子标本,采用显色培养基技术对耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Stphylococcus aureus,MRSA)、产超广谱β-内酰胺酶(Extended spectrumβ-lactamase producing Enterobacteriaceae,ESBLs)的肠杆菌科细菌及耐万古霉素肠球菌(Vancomycin-resistant Enterococcus,VRE)等常见的多重耐药菌进行快速筛查,了解两组患者不同部位的多重耐药菌阳性率及菌种分布情况。收集所有新入院患者的人口学特征、既往伴随疾病、本次入院前接受治疗情况、入院当日生命体征及感染相关情况等。结果:共十家医院的644例新入院患者接受了多重耐药菌快速筛查,其中研究组304例、对照组340例,其中男性333例(51.7%)年龄73(56,82)岁。多重耐药菌筛查阳性患者395例(61.3%),其中研究组220例(72.4%),显著高于对照组175例(51.5%)。鼻拭子阳性率研究组高于对照组(11.8%vs 3.2%,P0.05),以MRSA为著。而肛拭子的阳性率两组均高于鼻拭子,检出2种及以上多重耐药菌的概率,研究组显著高于对照组(18.9%vs 12.8%,P=0.046),以ESBLs阳性率最高。根据筛查结果分为阳性组与阴性组,阳性组中,更多患者既往患脑血管疾病(28.1%vs 17.3%,P=0.02)、入院前4周内手术史(21.0%vs 12.9%,P=0.008)、入院前4周内抗生素暴露史(38.0%vs 24.9%,P=0.001),其中既往患脑血管疾病史、入院前4周内手术史为多重耐药菌定植/感染的危险因素。结论:西城区区属医院入院患者多重耐药菌筛查阳性率高,其中三甲医院转入患者多重耐药菌定植率显著高于社区直接入院患者,肛拭子的阳性率高于鼻拭子,鼻拭子和肛拭子分别以MRSA、ESBLs阳性的ECO为著。既往患有脑血管疾病、入院前4周内手术史均为多重耐药菌定植/感染的危险因素。
[Abstract]:Objective: to investigate the colonization / infection status and risk factors of multidrug resistant bacteria (MDR) in patients admitted to hospitals in Xicheng District. Methods: this study was a prospective cohort study. According to the source of the patients, the patients were divided into study group (transferred to the third Class A Hospital) and the control group (direct admission to the community). The nasal swabs and / or anal swabs were collected from 10 newly admitted patients in Xicheng District from June 2014 to September 2015. Rapid screening of Methicillin-resistant Stphylococcus aureus resistant staphylococcus aureus, (Extended spectrum 尾 -lactamase producing Enterobacteriaceaeae bacteria, Vancomycin-resistant Enterococcus enterococcus Vre and other common multidrug resistant bacteria were carried out by color medium. To investigate the positive rate and distribution of multidrug resistant bacteria in different parts of the two groups. The demographic characteristics of all newly admitted patients, past associated diseases, pre-admission treatment, vital signs and infection related conditions were collected. Results: a total of 644 newly admitted patients in 10 hospitals were screened for multidrug resistant bacteria. 304 cases were in the study group and 340 cases in the control group. Among them, 333 cases (51.7%) were aged 73 (56 / 82) years old. 395 patients (61.3%) were screened positive for multidrug resistant bacteria, 220 cases (72.4%) in the study group were significantly higher than 175 cases (51.5%) in the control group. The positive rate of nasal swab in the study group was higher than that in the control group (11.8%vs 3.2), with MRSA as the main factor. The positive rate of anal swab in both groups was higher than that in nasal swab. The probability of detection of two or more multidrug resistant bacteria in the study group was significantly higher than that in the control group (18.9%vs 12.8P = 0.046), and the positive rate of ESBLs was the highest. According to the screening results, the patients were divided into positive group and negative group. In the positive group, more patients had cerebrovascular disease (28.1%vs 17.3), the history of operation within 4 weeks before admission (21.0%vs 12.9p 0.008), the history of antibiotic exposure within 4 weeks before admission (38.0%vs 24.9m), and the history of cerebrovascular disease. The history of operation within 4 weeks before admission was a risk factor for multidrug resistant bacteria colonization / infection. Conclusion: the positive rate of multidrug resistant bacteria screening in hospitals in Xicheng District is high, and the colonization rate of multidrug resistant bacteria in third Class A Hospital is significantly higher than that in community direct admission, and the positive rate of anal swab is higher than that of nasal swab. Nasal swabs and anal swabs were detected by MRSA-ESBLs positive ECO. The history of operation within 4 weeks before admission was a risk factor for multidrug resistant bacteria colonization / infection.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R446.5

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