首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 936-942.doi: 10.3969/j.issn.1006-7795.2021.06.006

• 重症医学基础与临床研究 • 上一篇    下一篇

北京市西城区区属医院入院患者多重耐药菌快速筛查情况分析

钱芳1,2, 姜利3*, 刘永东4, 黄晶5, 任燕明6, 刘玉东7, 李峨嵋8, 原景9, 裴爽10, 赵延11, 孙文秀12, 禹利燕13, 张晓萍14, 张新梅2, 王楠3   

  1. 1.浙江大学医学院附属第二医院综合ICU, 杭州 310000;
    2.首都医科大学附属复兴医院重症医学科, 北京 100038;
    3.首都医科大学宣武医院重症医学科, 北京 100053;
    4.北京市西城区医疗机构管理服务中心, 北京 100032;
    5.首都医科大学附属北京佑安医院感染管理处, 北京 100069;
    6.北京市西城区展览路医院院感科, 北京 100044;
    7.北京市宣武中医医院院感科, 北京 100050;
    8.北京市肛肠医院院感科, 北京 100120;
    9.北京中医药大学附属护国寺中医医院院感科, 北京 100035;
    10.北京丰盛中医骨伤专科医院院感科, 北京 100033;
    11.北京市西城区平安医院院感科, 北京 100055;
    12.北京市回民医院院感科, 北京100054;
    13.北京市西城区广外医院院感科, 北京100055;
    14.北京市第二医院院感科, 北京100031
  • 收稿日期:2021-09-10 出版日期:2021-12-21 发布日期:2021-12-17
  • 基金资助:
    北京市西城区可持续发展项目(SD2015-13)。

Screening for multidrug resistant organisms in patients admitted to the 10 community hospitals

Qian Fang1,2, Jiang Li3*, Liu Yongdong4, Huang Jing5, Ren Yanming6, Liu Yudong7, Li Emei8, Yuan Jing9, Pei Shuang10, Zhao Yan11, Sun Wenxiu12, Yu Liyan13, Zhang Xiaoping14, Zhang Xinmei2, Wang Nan3   

  1. 1. Comprehensive Intensive Care Medicine of the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China;
    2. Department of Intensive Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China;
    3. Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
    4. Beijing Xicheng District Medical Institution Management and Service Center, Beijing 100032, China;
    5. Department of Infection Management, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China;
    6. Department of Nosocomiology, Zhanlan Road Hospital, Xicheng District, Beijing 100044, China;
    7. Department of Nosocomiology,Beijing Xuanwu Hospital of Traditional Chinese Medicine, Beijing 100050, China;
    8. Department of Nosocomiology, Beijing Anorectal Hospital, Beijing 100120, China;
    9. Department of Nosocomiology, Huguosi Hospital affiliated to Beijing University of Chinese Medicine, Beijing 100035, China;
    10. Department of Nosocomiology, Beijing Fengsheng Traditional Chinese Medicine Hospital, Beijing 100033, China;
    11. Department of Nosocomiology, Beijing Xicheng District Pingan Hospital, Beijing 100055, China;
    12. Department of Nosocomiology, Beijing Huimin Hospital, Beijing 100054, China;
    13. Department of Nosocomiology, Guangwai Hospital, Xicheng District of Beijing, Beijing 100055, China;
    14. Department of Nosocomiology, Beijing Second Hospital, Beijing 100031, China
  • Received:2021-09-10 Online:2021-12-21 Published:2021-12-17
  • Contact: * E-mail: jiangli@sina.com
  • Supported by:
    Xicheng Sustainable Development Project(SD2015-13).

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摘要： 目的 了解北京市西城区各区属医院入院患者多重耐药菌(multidrug-resistant organisms,MDROs)筛查情况。方法 将北京市西城区十家区属医院,在2015年6月至2016年9月期间的入院患者,依患者来源,分为社区入院组(来自医院周边社区)和医院转入组(由区域内三甲医院出院后转入)。入院后48 h内采集鼻拭子和肛拭子,利用产色鉴定培养基技术,进行几种常见MDROs快速筛查,了解入院患者MDROs的筛查阳性比例、菌种分布,以及比较不同来源患者间的差异。结果 研究期间共纳入644例患者,其中医院转入组304例,占47.2%。医院转入组中至少一个部位一种细菌筛查阳性的患者比例,显著高于社区入院组(72.4% vs 51.5%,P<0.001)。鼻拭子筛查的阳性率,医院转入组同样高于社区入院组(11.8% vs 3.2%, P<0.001),以耐甲氧西林金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)阳性率最高。两组患者肛拭子的阳性率均高于鼻拭子,而肛拭子2种及以上细菌筛查阳性的患者,医院转入组也高于社区入院组(18.9% vs 12.8%, P=0.046),以大肠埃希菌(Escherichia coli,ECO)、克雷伯菌-肠杆菌-沙雷菌-柠檬酸杆菌(Klebsiella-Enterobacter-Serratia-Citrobacter,KESC)阳性率最高。既往脑血管疾病、高血压、入院前4周内手术或介入治疗史、抗菌药物暴露史及入院时存在SIRS,是入院患者MDROs筛查阳性的危险因素。结论 北京市西城区各区属医院入院患者MDROs筛查阳性率高,以区域内医院转入患者为著。应引起院感管理部门的高度重视。

关键词: 多重耐药菌, 快速筛查, 产色鉴定培养基, 社区转诊, 医院转诊

Abstract: Objective To investigate the patient screening for multidrug-resistant organisms (MDROs) on admission to the 10 community hospitals in Beijing. Methods The patients admitted to the 10 community hospitals in Xicheng district were enrolled in the study from June 11, 2015 to September 30, 2016. The patients were divided into hospital group and community group according to the place before admission. Nasal swabs and anal swabs were collected within 48 hours after admission. Chromogenic culture medium technology was used to identify methicillin resistant staphylococcus aureus (MRSA), extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae, and vancomycin resistant enterococcus (VRE). The positive percentage and distribution of the MDROs were compared between the groups. We also try to find risk factors for the positive MDROs. Results A total of 644 patients were enrolled in the study, among which 220 of the 304 patients in the hospital group showed positive screening at least one site, significantly higher than that of the 340 patients in community group (72.4% vs 51.5%, P<0.001). The positive percentage of nasal swab in hospital group was higher than that in the community group (11.8% vs 3.2%, P<0.001). The MRSA was the most found MDROs. The positive percentage of anal swab was higher than that of nasal swab in both groups. The patients with positive anal swab screening for 2 or more MDROs were significantly higher in the hospital group than that in the community group (18.9% vs 12.8%, P=0.046), especially with Escherichia coli (ECO) and Klebsiella-Enterobacter-Serratia-Citrobacter (KESC). Cerebrovascular disease, hypertension,surgery or interventional procedure, antibiotic exposure within 4 weeks prior to admission, and systemic inflammatory response syndrome (SIRS) on admission were risk factors for positive MDROs screening. Conclusion The positive MDROs screening were found in more than half of the patients admitted to the 10 community hospitals, especially, in patients transferred from tertiary hospital nearby. We should pay sufficient attention to these patients.

Key words: multidrug resistant organisms, screening, chromogenic medium, community referral, hospital referral

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