预防性接触隔离集束化措施对ICU多重耐药菌感染防控效果的研究

doi:10.3761/j.issn.2096-7446.2025.09.015

摘要/Abstract

摘要：

目的基于倾向性评分匹配的方法，探讨预防性接触隔离集束化措施对预防ICU患者多重耐药菌院内感染的效果。方法收集660例ICU成人患者的临床资料，根据是否实施预防性接触隔离集束化措施分为预防性接触隔离组和非预防性接触隔离组，其中预防性接触隔离组为177例，非预防性接触隔离组为483例。采用倾向性评分匹配法对两组患者的基本资料进行1 ∶ 1匹配。匹配变量包括入院途径、是否有手术史、急性生理与慢性健康评分Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）、是否为感染性休克、是否使用激素或免疫抑制剂、C反应蛋白、入住ICU时长，匹配后两组各纳入107例，比较两组患者院内感染及多重耐药菌感染的发生情况。结果匹配后两组患者的基线资料、APACHE Ⅱ评分等危险因素比较，差异均无统计学意义（P>0.05）。预防性接触隔离组院内感染的发生率（22.4%）低于非预防性接触隔离组（36.4%），差异具有统计学意义（P<0.05），但两组患者多重耐药菌感染的发生率差异无统计学意义（P>0.05）。结论对高风险患者实施预防性接触隔离集束化措施对降低ICU院内感染率有一定的效果，但多重耐药菌感染发生率未见明显降低。需要进一步研究将经验性预防接触隔离转变为科学精准筛选高危人群，并进行标准化预防方案的制订和实施。

关键词: ICU, 护理, 感染防控, 多重耐药菌, 接触隔离, 倾向性评分匹配

Abstract:

Objective To explore the effect of preventive contact isolation cluster measures on the prevention of multidrug-resistant organisms in ICU patients，based on the propensity score matching method（PSM）. Methods 660 adult patients were collected. According to the implementation of preventive contact isolation cluster measures，they were divided into implementation group and non-implementation group. 177 cases were in the implementation group and 483 cases were in the non-implementation group. The patients in the two groups were matched 1 ∶ 1 by the propensity score matching method. Matching variables were those that showed statistical differences in univariate analysis and common influencing factors between the two groups，including admission route，history of surgery，APACHE Ⅱ score，septic shock，use of hormones or immunosuppressants，C-reactive protein and the length of stay in ICU. After final matching，107 patients were included in each group，and the occurrence of nosocomial infection and multidrug-resistant organisms infection between the two groups were compared. Results There were no significant differences in baseline data，APACHE Ⅱ score and other risk factors between the two groups after PSM （P>0.05）. The incidence of nosocomial infection in the implementation group was slightly lower than that in the non-implementation group，and the difference was statistically significant（P<0.05），but there was no statistically significant difference in the incidence of multidrug-resistant organisms between the two groups（P>0.05）. Conclusion The implementation of preventive contact isolation cluster measures for high-risk patients has a certain effect on reducing the nosocomial infection rate in ICU，but the incidence of multidrug-resistant organisms has not been significantly reduced. In the future，it is hoped that empirical isolation will be transformed into the scientific and accurate screening of risk patients，and standardized intervention programs will be formulated and implemented.

Key words: ICU, Nursing Care, Infection Control, Multidrug-Resistant Organisms, Contact Isolation, Propensity Score Matching

袁翠, 肖艳艳, 陈凯笙, 王芳, 王轶, 胡美华, 姚希, 王东信, 李双玲. 预防性接触隔离集束化措施对ICU多重耐药菌感染防控效果的研究[J]. 中华急危重症护理杂志, 2025, 6(9): 1106-1111.

YUAN Cui, XIAO Yanyan, CHEN Kaisheng, WANG Fang, WANG Yi, HU Meihua, YAO Xi, WANG Dongxin, LI Shuangling. The effect of preventive contact isolation cluster measures on the prevention of multidrug-resistant organisms in ICU patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(9): 1106-1111.

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