葡萄糖酸氯己定擦浴预防ICU患者多重耐药菌感染

摘要

Objective To study the effect of chlorhexidine gluconate rubbing bathing on preventing multidrug-resistant organism(MDRO)infection in patients in intensive care unit(ICU).Methods 108 critically ill patients in a tertiary first-class hospital between January and December 2016 were randomly divided into trial group and control group.Trial group adopted wet towel containing 2％ chlorhexidine gluconate for bathing, control group adopted water for bathing.Bacteriostasis rate, incidence of healthcare-associated infection(HAI), occurrence of MDRO infection, and adverse reaction between two groups of patients after rubbing bathing were compared.Results There was no significant difference in the bacteriostasis rate within 2 hours between two groups(P＞0.05), bacteriostasis rates of trial group after 4, 8, and 24 hours of bathing were significantly higher than control group(P＜0.001).Incidences of HAI in trial group and control group were 44.44％(24/54)and 66.67％(36/54)respectively(P＜0.05); incidences of MDRO infection in trial group and control group were 20.37％(11/54)and 40.74％(22/54)respectively(P＜0.05).The main infection sites in trial group and control group were both lower respiratory tract, accounting for 87.50％and72.22％respectively;8 cases(33.33％)in trial group and11(30.55％)in control group had ventilator-associated pneumonia(VAP).11 strains of MDROs in trial group and 22in control group were isolated, both were mainly carbapenem-resistant Acinetobacter baumannii (CRAB).There was no adverse reaction after the bathing in both groups.Conclusion Application of chlorhexidine gluconate bathing can effectively reduce the incidence of HAI and MDRO infection in ICU patients.%目的 研究葡萄糖酸氯己定擦浴预防重症监护病房(ICU)患者多重耐药菌(MDRO)感染的作用.方法 选取2016年1—12月某三甲医院综合ICU收治的108例危重患者,随机分为试验组和对照组.试验组使用含2％葡萄糖酸氯己定的湿巾进行擦浴,对照组采用清水擦浴.比较两组患者擦拭后的抑菌率及医院感染、MDRO感染发病情况及不良反应发生情况.结果 两组患者在2 h内的抑菌率差异无统计学意义(P＞0.05),但在擦浴后4、8、24 h的抑菌率,试验组高于对照组,差异有统计学意义(P＜0.001).医院感染发病率试验组为44.44％(24/54),对照组为66.67％(36/54),两组比较差异有统计学意义(P＜0.05);MDRO发病率试验组为20.37％(11/54),对照组为40.74％(22/54),两组比较差异有统计学意义(P＜0.05).试验组与对照组患者医院感染部位均以下呼吸道为主,分别占87.50％、72.22％;其中试验组中呼吸机相关肺炎(VAP)8例(33.33％),对照组11例(30.55％).试验组共检出11株MDRO,对照组检出22株,均以耐碳青霉烯类鲍曼不动杆菌(CRAB)为主.两组患者在擦浴后均未发生不良反应.结论 使用葡萄糖酸氯己定擦浴可以有效减少ICU患者医院感染及MDRO感染的发生.