摘要
目的观察血液科肠道碳青霉烯类耐药的肠杆菌科细菌(CRE)主动筛查患者CRE定植、感染的特征,并评价主动筛查结合加强干预在血液科患者CRE感染预防控制中的效果。方法以2017年3月至2019年12月血液内科接受化疗或免疫抑制治疗且预期会出现粒细胞缺乏(粒缺)的患者为研究对象,进行至少3个时间点(治疗前、治疗后粒缺期、粒缺伴发热期)的肠道CRE筛查,以2016年12月至2017年2月血液内科未开展肠道CRE主动筛查的、接受化疗或免疫抑制治疗的115例患者为历史对照组,两组患者均进行CRE感染实时监测,CRE筛查阳性者均采取接触隔离措施,CRE筛查阳性者出现发热或者感染症状时启动针对CRE联合抗生素治疗。结果主动筛查患者CRE定植率为16.46%(66/401);病种分布上,以急性白血病定植率最高,为23.03%(26/113)。66例筛查阳性患者中,其中第1次筛查阳性患者为27例,占40.9%(27/66),第2次筛查阳性患者为15例,占22.7%(15/66),第3次及以后筛查阳性患者为24例,占36.4%(24/66)。CRE定植病原菌中耐碳青霉烯类肺炎克雷伯菌(CRKP)最多,占54.55%(36/66)。主动筛查患者CRE感染率(2.49%)及死亡率(50.00%)低于历史对照组的11.30%及69.23%;干预期间10例CRE血流感染患者病原菌种类与前期主动筛查病原菌完全相同,符合率为100.0%。结论血液科病房急性白血病患者CRE定植率最高,CRKP是CRE定植、感染的主要病原菌,提高筛查频率可以显著提高筛查阳性率,采取主动筛查并及早干预能有效降低血液科患者CRE发生率及死亡率,CRE筛查阳性病原菌与后续CRE感染病原菌符合率高。恶性血液病患者肠道CRE筛查可以对后期CRE血流感染起到预警以及优化抗菌药物使用的作用。
Objective To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae(CRE)active screening combined with enhanced intervention in the prevention and control of nosocomial infection in patients admitted to the hematological ward.Methods Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1,2017 to December 31,2019 and underwent chemotherapy or immunosuppressive therapy comprised the intervention group.They were screened for intestinal CRE at least thrice.From December 1,2016 to February 28,2017,patients who underwent chemotherapy or immunosuppressive therapy without active intestinal CRE screening in the Department of Hematology formed the control group.Both the patient groups were monitored for CRE infection in real time.The χ^2 test was used to compare the changes in the CRE infection rate and mortality in high-risk patients before and after the active screening.Results During the intervention period,the CRE colonization rate of patients was 16.46%(66/401);in terms of disease distribution,the colonization rate of acute leukemia was the highest 23.03%(26/113).Of the 66 colonized patients,27(40.9%)patients were identified as positive for CRE at the first screening,15(22.7%)were identified at the time of the second screening,and the remaining 24(36.4%)were identified at the third or subsequent screening;Carbapenem-resistant Klebsiella pneumoniae(CRPK)strains were dominant among the pathogens,accounting for 54.55%(36/66).During the active screening period,the CRE infection rate(2.49%)and mortality rate(50.00%)of high-risk patients were significantly lower than those of the controls(11.30%and 69.23%,respectively).The pathogens of 10 CRE infection patients during the intervention period were exactly the same as the previous active screening pathogens,and the coincidence rate was 100%.Conclusion The CRE colonization rate was the highest in patients with acute leukemia who were admitted in the hematology wards.CRPK is the main pathogen of CRE coloni
作者
黄细莲
吴盛海
施鹏飞
徐丽慧
陈灿
谢亚萍
高大泉
陈况
谭俊峰
刘利蓉
徐颖
杨帆
余梦霞
王淑颖
钱申贤
Huang Xilian;Wu Shenghai;Shi Pengfei;Xu Lihui;Chen Can;Xie Yaping;Gao Daquan;Chen Kuang;Tan Junfeng;Liu Lirong;Xu Ying;Yang Fan;Yu Mengxia;Wang Shuying;Qian Shenxian(Department of Hematology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine Hangzhou,Zhejiang 310006,China;Department of Microbiology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine Hangzhou,Zhejiang 310006,China;Department of Hospital Infection Prevention and Control,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine Hangzhou,Zhejiang 310006,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2020年第11期932-936,共5页
Chinese Journal of Hematology
基金
浙江省基础公益研究计划(LGF18H260009)
杭州市医药卫生计划(2018A05)
杭州市科技发展计划(20142013A61)。
