摘要
目的研究综合性医院多药耐药菌(MDROs)连续四年的检出率和医院感染趋势,探讨多学科协作(MDT)模式在MDROs管理中的应用效果。方法对2016-2019年MDROs检出率及医院感染发生率进行描述性研究,应用stata软件对实施MDT干预前后MDROs的检出率和医院感染发生率进行回归分析。结果耐碳青霉烯类鲍氏不动杆菌(CRABA)检出率最高93.53%,其次为耐甲氧西林金黄色葡萄球菌(MRSA)64.55%、耐碳青霉烯类肺炎克雷伯菌(CRKPN)45.99%和耐碳青霉烯类铜绿假单胞菌(CRPAE)38.58%,耐碳青霉烯类大肠埃希菌(CRECO)1.68%;除CRABA和CRECO外,其余耐药菌的检出率均呈现逐渐降低趋势;CRABA引起的医院感染人次数连续三年最高,CRECO引起的医院感染有逐年递增趋势,2019年CRKPN的感染人数较2016年大幅增加,MRSA的医院感染发生率及占比均呈现递减趋势;实施MDT前MDROs检出率的趋势系数(β1)为0.006,实施MDT管理模式之后趋势系数(β3)为-0.644(P=0.044);使用MDT管理模式之前MDROs的医院感染发生率趋势系数(β1)为0.255,使用MDT管理模式之后趋势系数(β3)为-0.638(P=0.015)。结论CRABA的检出率呈较高水平且引发的医院感染人次率居于首位,CRKPN感染人数占比大幅增加,CRECO引起的医院感染有逐年递增趋势,应继续加强防控。MDT管理模式在MDROs的检出率和医院感染发生率的变化趋势上有显著降低作用,为遏制多药耐药菌的扩散、防控多药耐药菌引起的感染提供强有力的支持。
OBJECTIVE To investigate the isolation rates of multidrug-resistant organisms(MDROs)and the trend of nosocomial infection,and to evaluate the effect of multidisciplinary team(MDT)management mode in the prevention and control of multidrug-resistant organisms(MDROs).METHODS To describe the isolation rates and incidences of nosocomial infection of MDROs in patients who were hospitalized from 2016 to 2019.The data before and after the MDT management were statistically analyzed by Stata software.RESULTS The detection rate of Carbapenem-resistant Acinetobacter baumannii(CRABA)was the highest(93.53%),followed by methicillin-resistant Staphylococcus aureus(MRSA)(64.55%),carbapenem-resistant Klebsiella pneumoniae(CRKPN)(45.99%),carbapenem-resistant Pseudomonas aeruginosa(CRPAE)(38.58%)and carbapenem-resistant Escherichia coli(CRECO)(1.68%),which showed a gradually decreasing trend.The incidence of nosocomial infection rates caused by CRABA was the highest from 2017 to 2019,and the nosocomial infection caused by CRECO have been increasing year by year.The proportion of CRKPN infection in 2019 was higher than that in 2016,and the infection rate and the proportion of MRSA showed a decreasing trend.After the implementation of the MDT management model,the trend coefficient(r3)of the MDROs detection rate was-0.664(P=0.044),while the trend coefficient(a3)of the nosocomial infections of MDROs was-0.638(P=0.015)before the implementation of the MDT management model.CONCLUSION The detection rates of CRABA were high,and the number of nosocomial infections was the largest.Infection rate caused by CRKPN was increasing and nosocomial infections of CRECO increased year by year,which should be payed close attention.The application of MDT model can effectively reduce the detection rate of MDROs and the incidence of nosocomial infections,reduce and control the spread of anti-drug bacteria.
作者
杨莉
陈茜
赖晓全
张涛
YANG Li;CHEN Xi;LAI Xiao-quan;ZHANG Tao(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第24期3817-3822,共6页
Chinese Journal of Nosocomiology
基金
湖北省自然科学基金资助项目(2019CFB112)。
关键词
多学科合作
多药耐药菌
医院感染
检出率
医院感染发生率
Multi-disciplinary team
Multidrug-resistant organism
Nosocomial infection
Isolation rate
Incidence of nosocomial infection rate
