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目的了解主动筛查与组合干预对多药耐药菌(MDROs)感染患者的实施成效,为制定科学有效的MDROs预防控制策略提供依据。方法采用目标性监测结合组合干预策略,选择2014年10月-2015年2月入住医院综合ICU>24h的患者374例为干预组,在MDROs主动筛查基础上推行组合干预措施,与该ICU2014年5-9月未实施组合干预的患者365例为常规组比较,观察两组患者医院感染调整日感染率、MDROs医院感染构成比、MDROs例次感染率、MDROs千日感染率、呼吸机相关性肺炎(VAP)千日感染率等变化。结果两组共监测患者739例,住院总日数1 664d;常规组、干预组医院感染率分别为3.29%、2.14%,例次感染率分别为3.56%、2.14%,日感染率分别为16.24‰、8.65‰,例次日感染率分别为17.59‰、8.65‰;MDROs医院感染为61.53%、25.00%;MDROs医院感染例次发生率为2.19%、0.53%;MDROs千日感染率为10.83‰、2.16‰;VAP千日感染率分别为34.09‰、11.44‰,与常规组比较,干预组各项感染率均有下降;MDROs千日感染率、VAP千日感染率差异有统计学意义(P<0.05)。结论推行主动筛查及组合干预技术预防控制多药耐药菌感染实施有效,可在临床推广。
Objective To understand the implementation effect of active screening and combination intervention on patients with multi-drug resistant bacteria (MDROs) infection and provide the basis for the establishment of a scientific and effective MDROs prevention and control strategy. Methods A total of 374 patients admitted to ICU for 24 hours in hospital from October 2014 to February 2015 were selected as the intervention group by targeted monitoring combined with combination intervention strategy. Combined interventions were implemented on the basis of MDROs active screening, From May to September, 365 patients without combined intervention were compared with those in the conventional group. The incidences of nosocomial infections such as adjusted daily nosocomial infections, the prevalence of MDROs nosocomial infections, the prevalence of MDROs, the prevalence of MDROs, the ventilator-related rate Pneumonia (VAP) millennium infection rate changes. Results The total number of hospitalized patients was 739 and the total number of hospitalization was 1 664 days. The prevalence rates of nosocomial infections in routine and intervention groups were 3.29% and 2.14% respectively, and the rates of nosocomial infections were 3.56% and 2.14% respectively. The daily infection rates were 16.24 ‰ , 8.65 ‰. The infection rates of the second day were 17.59 ‰ and 8.65 ‰ respectively. The incidences of MDROs were 61.53% and 25.00% respectively. The incidences of MDROs were 2.19% and 0.53% respectively. The infection rates of MDROs were 10.83 ‰, 2.16 ‰, respectively. The infection rates of VAP on a thousand days were 34.09 ‰ and 11.44 ‰, respectively. Compared with the conventional group, the infection rates in the intervention group decreased. The infection rates of the thousand-day MDAPs and the 1000-day VAP were statistically significant (P < 0.05). Conclusions The implementation of active screening and combination intervention in the prevention and control of multidrug-resistant bacterial infections is effective and can be clinically promoted.