摘要
目的分析ICU高危患者肠道及呼吸道碳青霉烯耐药菌(CRO)分布及临床特征,并评估平板筛选法及GeneXpertCarba(以下简称XpertCarba)两种筛查方法的效果。方法收集2023年4月-2024年12月苏州大学附属第四医院ICU病房收治的320例患者送检的肠道样本(肛拭子、粪便)及呼吸道样本(痰液、灌洗液),采用平板筛选法及XpertCarba法进行CRO菌株的主动筛查,并通过电子病历收集患者的临床资料。结果平板筛查结果显示,来自320例患者573份样本有70份CRO阳性,阳性率为12.22%(70/573),其中肛拭子、粪便、痰液和灌洗液阳性率分别为9.26%(20/216)、10.39%(8/77)、13.02%(22/169)和18.02%(20/111),各样本类型的阳性率差异无统计学意义。CRO阳性检出菌以肠道样本的肺炎克雷伯菌及呼吸道样本的铜绿假单胞菌为主。88例患者同时送检肠道样本及呼吸道样本共361份,平板筛选法及XpertCarba筛查阳性率分别为14.40%(52/361)及6.37%(23/361)。31例CRO阳性患者的临床特征分析显示,患者以高龄为主(平均年龄69岁),51.61%(16/31)有转科史,48.39%(15/31)有手术史。呼吸道阳性组机械通气使用率为(58.82%,10/17)高于肠道阳性组(0,0/7)和双阳性组(14.28%,1/7)。相比XpertCarba,平板筛选法筛查成本低、各样本类型的阳性率较高且检出菌种范围更广。结论ICU病房是CRO菌株高流行区域,以肺炎克雷伯菌(肠道样本)及铜绿假单胞菌(呼吸道样本)的分离率最高,平板筛查法是ICU高危患者肠道及呼吸道CRO菌株主动筛查的更经济、检出率高、菌种覆盖更广的方法。
OBJECTIVE To analyze the distribution and clinical characteristics of carbapenem-resistant organisms(CRO)in the intestinal and respiratory tracts of high-risk ICU patients,and to evaluate the effectiveness of two screening methods:plate screening and Gene Xpert Carba(hereinafter referred to as Xpert Carba).METHODS Intestinal samples(anal swabs,feces)and respiratory samples(sputum,lavage fluid)from 320 patients admitted to the ICU ward of the Fourth Affiliated Hospital of Soochow University from Apr.2023 to Dec.2024 were collected.Plate screening and Xpert Carba methods were used for active screening of CRO strains,and clinical data of patients were collected through electronic medical records.RESULTS The plate screening results indicated that 70 out of 573 samples from 320 patients tested positive for CRO,with a positive rate of 12.22%(70/573).The positive rates for anal swabs,feces,sputum and lavage fluid were 9.26%(20/216),10.39%(8/77),13.02%(22/169)and 18.02%(20/111),respectively.There was no statistically significant difference in the positive rates among different sample types.The predominant CRO-positive organisms detected were Klebsiella pneumoniae in intestinal samples and Pseudomonas aeruginosa in respiratory samples.Among 361 intestinal and respiratory samples tested from 88 patients,plate screening and Xpert Carba screening showed the positive rates of 14.40%(52/361)and 6.37%(23/361),respectively.Analysis of the clinical characteristics of the 31 CRO-positive patients revealed that they were predominantly elderly(average age 69 years),with 51.61%(16/31)having a history of interdepartmental transfers and 48.39%(15/31)having surgerical history.The mechanical ventilation usage rate in the respiratory positive group(58.82%,10/17)was higher than that in the intestinal positive group(0,0/7)and the dual positive group(14.28%,1/7).Compared with Xpert Carba,plate screening had lower screening costs,higher positive rates across different sample types and a broader range of detected bacterial species.CONCLUSIONS The ICU ward is a high-prevalence area for CRO strains,with K.pneumoniae(from intestinal samples)and P.aeruginosa(from respiratory samples)showing the highest isolation rates.Plate screening boasts lower costs,higher detection rate and broader bacterial species coverage for active screening of CRO strains in the intestinal and respiratory tracts of high-risk ICU patients.
作者
毕茹茹
韩清珍
王琳
褚晨
齐俊芳
高建瓴
BI Ruru;HAN Qingzhen;WANG Lin;CHU Chen;QI Junfang;GAO Jianling(The Fourth Affiliated Hospital of Soochow University,Suzhou Dushu Lake Hospital,Medical Center of Soochow Universtiy,Suzhou,Jiangsu 215123,China;不详)
出处
《中华医院感染学杂志》
北大核心
2025年第19期2989-2994,共6页
Chinese Journal of Nosocomiology
基金
苏州工业区园区医疗卫生创新研究基金资助项目(CXYJ2024A08)
“白求恩·医学研究基金”资助项目(2023-YJ-119-J-001)。
