多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用

仇桑桑; 许琴芬; 黄琴红; 龚裕卿; 吴波; 陈静瑜

doi:10.3969/j.issn.1674-7445.2024008

多学科综合诊疗模式在肺移植受者多重耐药菌感染防控的应用

doi: 10.3969/j.issn.1674-7445.2024008

1.
214023 江苏无锡，南京医科大学无锡医学中心无锡市人民医院南京医科大学附属无锡人民医院感染管理处
2.
214023 江苏无锡，南京医科大学无锡医学中心无锡市人民医院南京医科大学附属无锡人民医院肺移植中心

基金项目: 江苏省科技重点研发计划社会发展项目（BE2022697）；江苏省医院协会医院管理创新研究课题（JSYGY3-2023-326）；无锡市卫生健康委青年项目（Q202003）

详细信息

作者简介:

通讯作者:
许琴芬（ORCID 0009-0004-6168-3834），主任护师，研究方向为医院感染管理，Email：840800600@qq.com

中图分类号: R617, R37
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出版历程
- 收稿日期: 2024-01-05
- 网络出版日期: 2024-03-25

Application of multi-disciplinary team mode in prevention and control of multidrug resistant organism infection in lung transplant recipients

1.
Wuxi Medical Center, Nanjing Medical University, Wuxi People's Hospital, Department of Infection Management, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Medical Center of Nanjing Medical University, Wuxi 214023, China

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Corresponding author: Xu Qinfen, Email: 840800600@qq.com

摘要

摘要: 目的探讨多学科综合诊疗（MDT）模式在肺移植受者术后多重耐药菌（MDRO）感染防控中的实践效果。方法选择2019年至2022年的肺移植受者，从2020年1月开始成立MDT专家组，开展一系列防控措施，分析2020年至2022年MDRO防控措施落实率、环境物表MDRO检出率以及2019年至2022年肺移植受者MDRO检出率。结果医护人员总体MDRO防控措施落实率由2020年的64.9%上升至2022年的91.6%，呈逐年升高趋势（P＜0.05）。监测环境物表MDRO检出率从2020年的28%下降到2022年的9%，呈逐年下降趋势（P＜0.05）。肺移植受者MDRO检出率从2019年的66.7%降低至2022年的44.3%，呈逐年降低趋势（P＜0.001）。结论通过MDT模式管理，提高了医务人员MDRO防控措施的执行力，有效降低了肺移植受者术后MDRO感染率和环境物表MDRO检出率，值得推广利用。
- 肺移植 /
- 多重耐药菌 /
- 多学科综合诊疗 /
- 耐碳青霉烯类鲍曼不动杆菌 /
- 耐碳青霉烯类大肠埃希菌 /
- 耐碳青霉烯类肺炎克雷伯菌 /
- 耐甲氧西林金黄色葡萄球菌 /
- 耐碳青霉烯类铜绿假单胞菌
Abstract: Objective To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. Methods Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. Results The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (P<0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (P<0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (P<0.001). Conclusions MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application.

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图 1 MDT对肺移植受者MDRO感染防控管理技术路线图

Figure 1. Roadmap of MDT for MDRO infection prevention and control management in lung transplant recipients

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表 1 2020年至2022年MDRO防控措施落实率情况

Table 1. Implementation rate of MDRO prevention and control measures from 2020 to 2022

防控措施	2020年		2021年		2022年		χ²检验		趋势检验
防控措施	执行数/应执行数	执行率（%）	执行数/应执行数	执行率（%）	执行数/应执行数	执行率（%）	χ²值	P值	Z值	P值
总防控措施	721/1 111	64.9	858/1 093	78.5	104 7/1 143	91.6	237.71	<0.001	−15.41	<0.001
医生核心防控措施^①	285/460	62.0	348/439	79.3	419/463	90.5	108.43	<0.001	−10.33	<0.001
护士核心防控措施^②	436/651	67.0	510/654	78.0	628/680	92.3	131.50	<0.001	−11.43	<0.001

注：①医生核心防护措施包括接触隔离医嘱及时开具、手卫生依从、近距离操作防控、查房诊疗操作顺序正确、抗菌药物合理使用。　　　　②护士核心防控措施包括单间/床边隔离、患者专用物品和隔离标识配备、患者及家属宣教、床单元环境清洁消毒、医用织物和医疗废物正确处置、手卫生依从、近距离操作防控。

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表 2 2020年至2022年环境物表卫生学MDRO检出情况

Table 2. The detection of MDRO in environmental surface hygiene from 2020 to 2022

细菌名称	2020年		2021年		2022年		χ²检验		趋势检验
细菌名称	检出数/特定细菌数	检出率^①（%）	检出数/特定细菌数	检出率^①（%）	检出数/特定细菌数	检出率^①（%）	χ²值	P值	Z值	P值
MRSA	11/36	31	6/31	19	3/28	11	3.81	0.15	1.94	0.053
CRKP	5/35	14	2/15	13	0/9		1.43	0.49	0.70	0.485
CRAB	6/9		1/4		1/9		5.63	0.043	2.40	0.017
合计	22	28	9	18	4	9	6.41	0.04	2.57	0.01
注：①合计例数较少的（＜10），不统计百分率。

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表 3 2019年至2022年肺移植受者MDRO检出情况

Table 3. Detection of MDRO in lung transplant recipients from 2019 to 2022

细菌名称	2019年		2020年		2021年		2022年		χ²检验		趋势检验
细菌名称	检出数/特定细菌数	检出率（%）	检出数/特定细菌数	检出率（%）	检出数/特定细菌数	检出率（%）	检出数/特定细菌数	检出率（%）	χ²值	P值	Z值	P值
CREC	4/11	36.4	3/17	17.6	3/15	20.0	2/25	8.0	4.3	0.230	1.87	0.062
CRKP	81/112	72.3	60/97	61.9	50/104	48.1	39/91	42.9	22.4	<0.001	4.67	<0.001
MRSA	16/30	53.3	11/31	35.5	13/40	32.5	9/38	23.7	6.7	0.084	2.46	0.014
CRAB	93/113	82.3	82/99	82.8	85/126	67.5	59/89	66.3	13.7	0.003	3.33	<0.001
CRPA	66/124	53.2	47/113	41.6	57/124	46.0	50/116	43.1	3.9	0.275	1.31	0.190
合计	260/390	66.7	203/357	56.9	208/409	50.9	159/359	44.3	46.4	<0.001	6.74	<0.001

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