【摘要】：目的:了解西城區(qū)區(qū)屬醫(yī)院入院患者多重耐藥菌定植/感染情況及危險因素。方法:本研究為前瞻性隊列研究。根據(jù)患者來源,將入院患者分為研究組(三甲醫(yī)院轉(zhuǎn)入)及對照組(社區(qū)直接入院),收集2014年6月至2015年9月西城區(qū)區(qū)屬十家醫(yī)院新入院患者鼻拭子和(或)肛拭子標本,采用顯色培養(yǎng)基技術對耐甲氧西林金黃色葡萄球菌(Methicillin-resistant Stphylococcus aureus,MRSA)、產(chǎn)超廣譜β-內(nèi)酰胺酶(Extended spectrumβ-lactamase producing Enterobacteriaceae,ESBLs)的腸桿菌科細菌及耐萬古霉素腸球菌(Vancomycin-resistant Enterococcus,VRE)等常見的多重耐藥菌進行快速篩查,了解兩組患者不同部位的多重耐藥菌陽性率及菌種分布情況。收集所有新入院患者的人口學特征、既往伴隨疾病、本次入院前接受治療情況、入院當日生命體征及感染相關情況等。結果:共十家醫(yī)院的644例新入院患者接受了多重耐藥菌快速篩查,其中研究組304例、對照組340例,其中男性333例(51.7%)年齡73(56,82)歲。多重耐藥菌篩查陽性患者395例(61.3%),其中研究組220例(72.4%),顯著高于對照組175例(51.5%)。鼻拭子陽性率研究組高于對照組(11.8%vs 3.2%,P0.05),以MRSA為著。而肛拭子的陽性率兩組均高于鼻拭子,檢出2種及以上多重耐藥菌的概率,研究組顯著高于對照組(18.9%vs 12.8%,P=0.046),以ESBLs陽性率最高。根據(jù)篩查結果分為陽性組與陰性組,陽性組中,更多患者既往患腦血管疾病(28.1%vs 17.3%,P=0.02)、入院前4周內(nèi)手術史(21.0%vs 12.9%,P=0.008)、入院前4周內(nèi)抗生素暴露史(38.0%vs 24.9%,P=0.001),其中既往患腦血管疾病史、入院前4周內(nèi)手術史為多重耐藥菌定植/感染的危險因素。結論:西城區(qū)區(qū)屬醫(yī)院入院患者多重耐藥菌篩查陽性率高,其中三甲醫(yī)院轉(zhuǎn)入患者多重耐藥菌定植率顯著高于社區(qū)直接入院患者,肛拭子的陽性率高于鼻拭子,鼻拭子和肛拭子分別以MRSA、ESBLs陽性的ECO為著。既往患有腦血管疾病、入院前4周內(nèi)手術史均為多重耐藥菌定植/感染的危險因素。
[Abstract]:Objective: to investigate the colonization / infection status and risk factors of multidrug resistant bacteria (MDR) in patients admitted to hospitals in Xicheng District. Methods: this study was a prospective cohort study. According to the source of the patients, the patients were divided into study group (transferred to the third Class A Hospital) and the control group (direct admission to the community). The nasal swabs and / or anal swabs were collected from 10 newly admitted patients in Xicheng District from June 2014 to September 2015. Rapid screening of Methicillin-resistant Stphylococcus aureus resistant staphylococcus aureus, (Extended spectrum 尾 -lactamase producing Enterobacteriaceaeae bacteria, Vancomycin-resistant Enterococcus enterococcus Vre and other common multidrug resistant bacteria were carried out by color medium. To investigate the positive rate and distribution of multidrug resistant bacteria in different parts of the two groups. The demographic characteristics of all newly admitted patients, past associated diseases, pre-admission treatment, vital signs and infection related conditions were collected. Results: a total of 644 newly admitted patients in 10 hospitals were screened for multidrug resistant bacteria. 304 cases were in the study group and 340 cases in the control group. Among them, 333 cases (51.7%) were aged 73 (56 / 82) years old. 395 patients (61.3%) were screened positive for multidrug resistant bacteria, 220 cases (72.4%) in the study group were significantly higher than 175 cases (51.5%) in the control group. The positive rate of nasal swab in the study group was higher than that in the control group (11.8%vs 3.2), with MRSA as the main factor. The positive rate of anal swab in both groups was higher than that in nasal swab. The probability of detection of two or more multidrug resistant bacteria in the study group was significantly higher than that in the control group (18.9%vs 12.8P = 0.046), and the positive rate of ESBLs was the highest. According to the screening results, the patients were divided into positive group and negative group. In the positive group, more patients had cerebrovascular disease (28.1%vs 17.3), the history of operation within 4 weeks before admission (21.0%vs 12.9p 0.008), the history of antibiotic exposure within 4 weeks before admission (38.0%vs 24.9m), and the history of cerebrovascular disease. The history of operation within 4 weeks before admission was a risk factor for multidrug resistant bacteria colonization / infection. Conclusion: the positive rate of multidrug resistant bacteria screening in hospitals in Xicheng District is high, and the colonization rate of multidrug resistant bacteria in third Class A Hospital is significantly higher than that in community direct admission, and the positive rate of anal swab is higher than that of nasal swab. Nasal swabs and anal swabs were detected by MRSA-ESBLs positive ECO. The history of operation within 4 weeks before admission was a risk factor for multidrug resistant bacteria colonization / infection.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R446.5

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