摘要
目的分析重症监护病房(ICU)老年患者多药耐药菌(MDROs)感染分布及来源,为老年患者制定针对性MDROs防控策略提供依据。方法收集江苏省人民医院2017年7月-2019年6月8个ICU的患者MDROs感染资料,分为老年患者(>65岁)和非老年患者(≤65岁),MDROs感染来源分为医院感染(本院转入和科室获得)和院外感染(外院转入和社区获得)。结果 ICU中老年患者共检出感染的MDROs 852株,非老年患者共检出感染的MDROs 1 045株。老年患者和非老年患者MDROs感染构成均以耐碳青霉烯类鲍氏不动杆菌(CRAB)和耐碳青霉烯类肠杆菌科(CRE)为主。两组患者MDROs感染部位前两位均为下呼吸道感染和血流感染,老年患者下呼吸道感染占比(86.74%)高于非老年患者(79.23%),差异有统计学意义(P<0.001)。两组患者MDROs感染来源院外感染比例(53.87%和55.89%)均高于医院感染(46.13%和44.11%)。8个ICU老年患者的CRE感染数量最多的前三位分别是综合ICU(33.92%)、老年ICU(26.53%)和神外ICU(9.51%)。ICU老年患者MDROs来源外院转入占23.24%,社区获得占30.63%,本院转入占6.92%,科室获得占39.20%。CRAB、CRPA及CRE感染来源在各ICU之间的差异均有统计学意义(P<0.001)。结论 ICU老年患者MDROs感染分布具有一定特殊性,感染来源在不同ICU也存在多样性,需根据其特点,采取针对性措施,实现精准化防控。
OBJECTIVE To investigate the distribution and sources of elderly patients with multidrug-resistant organisms(MDROs) infections in intensive care unit(ICU) so as to provide guidance for development of targeted strategies for prevention of MDROs infection in the elderly patients. METHODS The clinical data were collected from the patients with MDROs infection who were treated in 8 ICUs of Jiangsu Province Hospital from Jul 2017 to Jun 2019, the enrolled patients were divided into the elderly patient group(more than 65 years old) and the non-elderly patient group( no more than 65 years old). The sources of MDROs infection were divided into the nosocomial infection(transferred from the hospital and acquired from department) and the out-of-hospital infection( transferred from outside hospital and acquired from community). RESULTS A total of 852 strains of MDROs were isolated from the elderly patients with infection in ICUs, and 1 045 strains of MDROs were isolated from the non-elderly patients. Carbapenem-resistant Acinetobacter baumannii(CRAB) and carbapenem-resistant Enterobacteriaceae(CRE) were dominant among the MDROs causing the infection in the elderly patients and the non-elderly patients. The lower respiratory tract and blood stream ranked the top 2 infection sites of the two groups of patients with MDROs infections. The proportion of the elderly patients with lower respiratory tract infection was 86.74%, significantly higher than 79.23% of the non-elderly patients(P<0.001). The proportions of the two groups of patients with out-of-hospital MDROs infection(53.87% and 55.89%)were higher than those of the two groups of patients with nosocomial MDROs infections(46.13% and 44.11%). Among the 8 ICUs in which the elderly patients had CRE infection, the general ICU( 33.92%), geriatric ICU(26.53%) and neurosurgery ICU(9.51%) ranked the top 3. Among the elderly ICU patients with MDROs infections, 23.24% were transferred from foreign hospitals, 30.63% were community-acquired, 6.92% were transferred from the hospital, and 39.20% were department-acquired. There were significant differences in the sources of CRAB, CRPA and CRE infections among the ICUs(P<0.001). CONCLUSION The distribution of the elderly ICU patients with MDROs infection is specific, the sources of the infections are diverse in the ICUs, and it is necessary to take targeted measures according to the characteristics so as to realized the precise prevention.
作者
臧凤
张永祥
刘波
陈文森
张卫红
刘云
李占结
ZANG Feng;ZHANG Yong-xiang;LIU Bo;CHEN Wen-sen;ZHANG Wei-hong;LIU Yun;LI Zhan-jie(The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第6期866-871,共6页
Chinese Journal of Nosocomiology
基金
国家重点研发计划基金资助项目(2018YFC1314900,2018YFC1314901)
中国老年医学学会感染防控研究基金资助项目(GRYJ-XL2018009,GRYJ-XL2018016)
江苏省科技厅重点研发计划基金资助项目(BE2016002-4)
江苏省医院管理创新研究基金资助项目(JSYGY-3-2019-484)。
关键词
老年患者
重症监护病房
多药耐药菌
感染来源
Elderly patient
Intensive care unit
Multidrug-resistant organism
Source of infection
