Li Zhan-Jie, Wang Ke-Wei, Liu Bo, Zang Feng, Zhang Yu, Zhang Wei-Hong, Zhou Su-Ming, Zhang Yong-Xiang
Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China.
Institute of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, People's Republic of China.
Infect Drug Resist. 2021 Nov 27;14:4983-4991. doi: 10.2147/IDR.S332196. eCollection 2021.
To analyze the distribution and source of MDROs infection in the ICUs and to provide a basis for formulating more effective prevention and control programs for MDROs.
A retrospective investigation was conducted on MDROs infection in 8 ICUs of a large tertiary hospital from July 2013 to June 2019. A total of 2629 strains of MDROs isolated from 1701 inpatients were selected for analysis. The MDROs of the 8 ICUs were divided into two types of four categories according to source: out-of-hospital (out-of-hospital transfer and community acquisition) and in-hospital (in-hospital transfer and department acquisition) infections.
CRAB (41.84%) and CRE (35.07%) accounted for the majority of the infecting MDROs. The detection rates of MRSA, CRAB, CRPA and CRE were 61.24%, 83.75%, 43.01% and 30.15%, respectively. The top three infection sites of MDROs were the lower respiratory tract (81.10%), blood (6.70%) and abdominal cavity (5.80%). The out-of-hospital and in-hospital infection rates of MDROs were 50.51% and 49.49%, respectively; the out-of-hospital infection rates for MRSA, CRAB, CRPA and CRE were 43.56%, 55.91, 64.44% and 44.58%, respectively. The proportions of MRSA, CRAB, CRPA and CRE infections contracted in the department were 40.98%, 36.27%, 25.56% and 46.62%, respectively. There was a statistically significant difference between comprehensive ICU and specialized ICU wards as sources for CRAB infections (P < 0.001).
The main source of MDROs in the ICU is not the hospital itself entirely. It is particularly important to strengthen the identification of MDRO sources and implement more effective and accurate infection prevention and control measures.
分析重症监护病房（ICU）中多重耐药菌（MDROs）感染的分布及来源，为制定更有效的MDROs预防控制方案提供依据。
对某大型三级医院8个ICU在2013年7月至2019年6月期间的MDROs感染情况进行回顾性调查。共选取从1701例住院患者中分离出的2629株MDROs进行分析。将8个ICU的MDROs按来源分为院外（院外转入和社区获得）和院内（院内转入和科室获得）感染两类四组。
鲍曼不动杆菌耐药株（CRAB，41.84%）和产超广谱β-内酰胺酶肠杆菌科细菌（CRE，35.07%）占感染MDROs的大多数。耐甲氧西林金黄色葡萄球菌（MRSA）、CRAB、耐碳青霉烯类铜绿假单胞菌（CRPA）和CRE的检出率分别为61.24%、83.75%、43.01%和30.15%。MDROs感染的前三位部位是下呼吸道（81.10%）、血液（6.70%）和腹腔（5.80%）。MDROs的院外和院内感染率分别为50.51%和49.49%；MRSA、CRAB、CRPA和CRE的院外感染率分别为43.56%、55.91%、64.44%和44.58%。在科室感染的MRSA、CRAB、CRPA和CRE比例分别为40.98%、36.27%、25.56%和46.62%。作为CRAB感染来源，综合ICU和专科ICU病房之间存在统计学显著差异（P < 0.001）。
ICU中MDROs的主要来源并非完全是医院本身。加强对MDROs来源的识别并实施更有效、准确的感染预防控制措施尤为重要。
