【摘要】 目的 评估主动筛查对提高重症监护病房(ICU)耐碳青霉烯类肠杆菌目细菌(CRE)检出率的效果。方法 于2023年7月—2024年6月对10所医院ICU患者进行直肠拭子CRE主动筛查。将2023年7月—2024年6月实施主动筛查的ICU住院患者作为研究组，2022年7月—2023年6月未实施主动筛查的ICU住院患者作为对照组，比较两组患者CRE检出率的差异。结果 研究组纳入ICU患者7 803例，检出CRE 744株，检出率为9.53%;其中常规检测检出CRE 304株(检出率3.90%),主动筛查患者3 707例，检出CRE 440株(检出率11.87%)。对照组纳入ICU患者7 561例，常规检测检出CRE 250株，检出率为3.31%。两组患者CRE总检出率比较，差异有统计学意义(χ~2=246.18,P<0.001)。研究组主动筛查的CRE检出率(11.87%)高于常规检测的CRE检出率(3.90%),差异有统计学意义(χ~2=264.26,P<0.001)。研究组共检出CRE菌株17种，常规检测组中肺炎克雷伯菌(80.92%VS 73.41%)和黏质沙雷菌(2.30%VS 0.23%)占比高于主动筛查组，而常规检测组中大肠埃希菌占比低于主动筛查组(8.22%VS 19.55%),差异均有统计学意义(均P<0.05)。结论 ICU内CRE流行率较高，细菌种类广泛，主动筛查可提高CRE检出率。更多还原

【Abstract】 Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales(CRE) in the intensive care units(ICUs). Methods From July 2023 to June 2024, active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals. ICU patients who underwent active screening from July 2023 to June 2024 were selected as the study group, while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group. Difference in CRE detection rates between the two groups of patients was compared. Results A total of 7 803 ICU patients were included in the study group, 744 CRE strains were detected, with a detection rate of 9.53%, out of which 304 CRE strains were detected through routine detection(detection rate 3.90%), 3 707 patients underwent active screen, 440 CRE strains were detected(detection rate 11.87%). 7 561 ICU patients were included in the control group, out of which 250 CRE strains were detected through routine detection, with a detection rate of 3.31%. There was a statistically significant difference in the overall detection rate of CRE between two groups of patients(χ~2=246.18, P<0.001). In the study group, CRE detection rate of active screening(11.87%) was higher than that of routine detection(3.90%), with statistically significant difference(χ~2=264.26, P<0.001). A total of 17 CRE strains were detected from the study group. The proportions of Klebsiella pneumoniae(80.92% vs 73.41%) and Serratia marcescens(2.30% vs 0.23%) in the routine detection group were both higher than in the active screening group, while the proportion of Escherichia coli in the routine detection group was lower(8.22% vs 19.55%), all with statistically significant differences(all P<0.05). Conclusion The prevalence of CRE in ICUs is relatively high, with a wide range of bacterial species. Active screening can improve the detection rate of CRE.更多还原