RICU多重耐药菌的耐药及危险因素分析  

Analysis on the Antibiotics Resistance and Risk Factors of Multidrug Resistant Bacteria in Respiratory Intensive Care Unit

作　　者：杨慧[1] 向平超[1] 郭伟安[1] 孙佳[1] 宋丽萍[1] 张硕[1] 

机构地区：[1]北京大学首钢医院呼吸与危重症医学科,北京100144

出　　处：《中国呼吸与危重监护杂志》2010年第1期19-22,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨呼吸重症监护病房(RICU)多重耐药菌的分布特点、耐药情况,以及多重耐药菌感染的危险因素。方法采用回顾性调查的方法,对2008年4月至2009年5月收住RICU的79例患者的病原菌进行分析。同时在非多重耐药、多重耐药及泛耐药三组患者之间进行多重耐药菌危险因素分析。结果分离出的129株病原菌中前三位分别为铜绿假单胞菌(24.0%)、金黄色葡萄球菌(22.5%)及鲍曼不动杆菌(15.5%);多重耐药菌72株,前三位分别为金黄色葡萄球菌(38.9%)、铜绿假单胞菌(25.0%)及鲍曼不动杆菌(19.4%)。泛耐药菌29株,以铜绿假单胞菌(48.3%)及鲍曼不动杆菌(44.8%)为主。多因素Logistics回归分析显示入住RICU次数、应用碳青霉烯类抗生素、机械通气时间、留置导尿时间及合并糖尿病为多重耐药菌感染的独立危险因素。结论RICU多重耐药菌感染发生率高。患者入住RICU次数、应用碳青霉烯类抗生素、机械通气时间、留置导尿时间及合并糖尿病与患者发生多重耐药菌感染有密切关系。Objective To investigate the antibiotic resistance distribution and profiles of multidrug resistant bacteria in respiratory intensive care unit （ RICU）, and to analyze the related risk factors for multidrug resistant bacterial infections. Methods Pathogens from 79 patients in RICU from April 2008 to May 2009 were analyzed retrospectively. Meanwhile the risk factors were analyzed by multi-factor logistic analysis among three groups of patients with non-multidrug, muhidrug and pandrug-resistant bacterial infection. Results The top three in 129 isolated pathogenic bacteria were Pseudomonas aeruginosa （24.0%）, Staphylococcus aureus （ 22. 5% ）, and Acinetobacter baumannii （ 15.5% ）. The top three in 76 isolated muhidrug-resistant bacteria were Staphylococcus aureus （38.9%）, Pseudomonas aeruginosa （25.0%） ,and Acinetobacter baumannii（ 19. 4% ）. And the two main strains in 29 isolated pandrug-resistant bacteria were Pseudomonas aeruginosa （ 48. 3% ） and Acinetobacter baumannii （ 44. 8% ） . Multi-factor logistic analysis revealed that the frequency of admition to RICU, the use of carbapenem antibiotics, the time of mechanical ventilation, the time of urethral catheterization, and complicated diabetes mellitus were independent risk factors for multidrug-resistant bacterial infection （ all P 〈 0. 05 ）. Conclusions There is a high frequency of multidrug-resistant bacterial infection in RICU. Frequency of admition in RICU, use of carbapenem antibiotics, time of mechanical ventilation, time of urethral catheterization, and complicated diabetes mellitus were closely related with multidrug-resistant bacterial infection .

关 键 词：呼吸重症监护病房 多重耐药菌 泛耐药菌 危险因素 

分 类 号：R56[医药卫生—呼吸系统] R446.5[医药卫生—内科学]