耐药菌筛查联合组合式降阶梯集束化防控降低ICU感染的疗效分析

摘要

Objective To explore the therapeutic effect of drug resistant bacteria screening combined withCombined de-scending ladder cluster control on reducing infection in intensive care unit(ICU).Methods 120 critically ill patients who met the inclusion criteriaadmitted from January 2012 to December 2015 were selected.According to the random number table method,they were divided into control group(n=60)and combined group(n=60).Screening drug resistant bacteria in the control group,while for the combined group,descending-ladder cluster control was added on the basis of control group.The detection rate,the number of sterile cases,the thousand-day rate of acquired drug-resistant bacteria and the prognosis were compared between the two groups of drug resistant strains.Results In the control group and the combined group,43 strains and 30 strains were detected respectively,the detection rates were 71.67%(43/60)and 50%(30/60)respectively,and the difference was statistically significant(2 =5.91,P=0.02);The ICU acquired drug-resistant strains were 29 strains and 17 strains respectively,and the detection rates of drug resistant strains were 48.33%(29/60)and 28.33%(17/60),respectively.The difference was statistically significant( =5.08,P=0.02);There was no significant difference in the number of aseptic cases between the two groups( =2.14,P=0.14).In control group,the thousand-day rate of ICU acquired drug-resistant bacteria,the rate of ICU acquired bloodstream infection,the incidence of ICU ac-quired pneumonia and the rate of ICU acquired intra abdominal infection were 7.31‰、2.09‰、3.66‰、2.09‰;The combined groups were 5.95‰、1.40‰、3.50‰、1.40‰,respectively;Compared with the control group,the combined group shortened the aver-age days of hospitalization,and reduced the mortality rate,the mortality rate of 28d,the fatality rate of 90d and the death rate of attrib-utable infection.Conclusion The combination of drug-resistant bacteria screening and combined descending ladder cluster control can effectively reduce ICU infection,shorten the time of hospitalization and improve the prognosis of patients.%目的 探究耐药菌筛查联合组合式降阶梯集束化防控降低重症监护病房(ICU)感染的疗效.方法 选取我院在2012年1月至2015年12月期间收治的、符合纳入标准的危重患者120例.按随机数字表法分为对照组(n=60)和联合组(n=60),对照组使用耐药菌筛查,联合组在对照组的基础上增加组合式降阶梯集束化防控.对比两组耐药菌株检出率、无菌例数、获得性耐药菌千日率及预后情况.结果 对照组与联合组耐药菌株分别检出43株和30株,检出率分别为71.67%(43/60)、50.00%(30/60),差异具体统计学意义( =5.91,P=0.02);对照组与联合组ICU内获得性耐药菌株分别为29株和17株,耐药菌株检出率分别为48.33%(29/60)、28.33%(17/60),差异有统计学意义( =5.08, P=0.02);两组无菌病例数差异无统计学意义( =2.14,P=0.14);对照组ICU内获得性耐药菌千日率、ICU内获得性血流感染发生率、ICU内获得性肺炎发生率、ICU内获得性腹腔感染发生率分别为7.31‰、2.09‰、3.66‰、2.09‰;联合组分别为5.95‰、1.40‰、3.50‰、1.40‰;与对照组相比,联合组缩短平均住院天数,并降低住院期间病死率、28d病死率、90d病死率及感染归因病死率.结论 耐药菌筛查联合组合式降阶梯集束化防控能有效降低ICU感染,缩短住院时间,提高患者预后效果.