摘要目的:探讨基于多学科诊疗模式(MDT)的耐药菌协作管理方式对重症监护病房(ICU)碳青霉烯类耐药肠杆菌科细菌(CRE)的防控效果。方法:采用历史对照研究对2018年1月至2019年12月连云港市第一人民医院急诊ICU和神经外科ICU的住院患者进行分析，其中2018年入住ICU患者作为对照组，共1 076例，采用一般耐药菌防控模式，2019年入住ICU患者为干预组，共1 237例，推行针对CRE的MDT防控模式。采用χ 2检验比较干预前后两组患者CRE感染发现率、CRE检出率、抗菌药物使用强度和防控措施落实的依从性。 结果:采取MDT防控模式干预后，急诊ICU和神经外科ICU的CRE感染发现率分别由3.45%(14/406)和3.58%(24/670)下降至1.65%(9/547)和2.32%(16/690)，CRE检出率分别由66.21%(96/145)和57.72%(86/149)下降至41.11%(51/124)和33.06%(40/121)，病原菌均以碳青霉烯类耐药肺炎克雷伯菌(CRKP)为主。碳青霉烯类抗菌药物使用合理率由65.00%(78/120)显著提高至92.73%(319/344)(χ 2＝55.382，P<0.05)；且干预组在单间隔离落实率、专组化护理率、物表清除率以及医疗用品专用率上较对照组有所提升(χ 2＝21.646、18.116、39.869和19.713，P<0.01)。 结论:通过构建基于MDT模式的耐药菌多部门协作防控能有效提升ICU内CRE的防控成效，降低CRE感染的发生。

abstractsObjective:To evaluate the effectiveness of multi-disciplinary treatment (MDT) for reducing carbapenem-resistant Enterobacteriaceae (CRE) infections in intensive care unit(ICU).Methods:Patients admitted in the emergency ICU (EICU) and neurosurgical ICU (NICU) of the First People’s Hospital of Lianyungang during January 2018 to December 2019 were enrolled in the study, which was analyzed by historical control study. For patients admitted in 2018, the conventional method was adopted for prevention and control of drug-resistant bacteria (control group, n=1, 076), and for patients admitted in 2019, the MDT was adopted for the prevention and control of CRE (intervention group, n=1, 237). Chi-square test was used to compare the incidence rate of CRE infection, CRE detection rate, rate of rational antibiotic use and compliance with implementation of prevention and control measures between two groups. Results:Compared to control group, the incidence rate of CRE infection in EICU and NICU decreased from 3.45% (14/406) and 3.58% (24/670) to 1.65% (9/547) and 2.32% (16/690) in intervention group, respectively; while the detection rate of CRE decreased from 66.21% (96/145) and 57.72% (86/149) to 41.11% (51/124) and 33.06% (40/121), the pathogens were mainly carbapenem-resistant Klebsiella pneumoniae (CRKP). The rational medication rate of carbapenem antibiotics was significantly increased from 65.00%(78/120) in 2018 to 92.73%(319/344) in 2019 ( χ2=55.382, P<0.05). In addition, the single room isolation rate, the rate of specialized nursing care, the cleaning and disinfection quality of bench surface and the special use rate of articles were also significantly improved( χ2=21.646, 18.116, 39.869 and 19.713, P<0.01). Conclusion:The establishment of multi-department collaborative management based on MDT can effectively improve the prevention and control effect of CRE in ICU and significantly reduce the prevalence of CRE infection.