重症监护室医院下呼吸道感染常见非发酵菌的耐药性与危险因素  

Drug resistance and risk factors of non-fermentative bacterial healthcare-associated lower respiratory tract infection in an intensive care unit

作　　者：贾育红[1] 袁天柱[1] 刘滨[1] 

机构地区：[1]广西医科大学第四附属医院,广西柳州545005

出　　处：《中国感染控制杂志》2012年第2期104-108,共5页Chinese Journal of Infection Control

摘　　要：目的探讨某院重症监护室(ICU)3种常见非发酵菌医院获得性下呼吸道感染的耐药性及多重耐药非发酵菌下呼吸道感染的危险因素。方法对该院2009年1月—2010年12月ICU患者下呼吸道分离的182株3种常见非发酵菌分布及耐药情况进行分析;Logistic回归分析其中91例多重耐药菌医院获得性下呼吸道感染的危险因素。结果 ICU下呼吸道感染最常见的3种非发酵菌分别是铜绿假单胞菌(41.36%,79/191)、鲍曼不动杆菌(40.32%,77/191)及嗜麦芽窄食单胞菌(13.62%,26/191)。鲍曼不动杆菌对第三、四代头孢菌素及喹诺酮类、氨基糖苷类药物耐药率达80%以上;铜绿假单胞菌对亚胺培南的耐药率在35%以上,对头孢曲松、头孢噻肟的耐药率达70%以上;嗜麦芽窄食单胞菌对复方磺胺甲口恶唑的耐药率,2010年(66.67%)与2009年(7.14%)相比,显著上升(χ2=7.66,P=0.00),并出现了耐米诺环素菌株(8.33%)。医院感染持续时间>2周(OR=4.53,P=0.03)、联合用药时间>72 h(OR=3.51,P=0.03)是独立的ICU多重耐药非发酵菌医院获得性下呼吸道感染危险因素。结论非发酵菌为ICU医院获得性下呼吸道感染的重要病原菌,耐药严重。严格把握入住ICU临床标准,针对有意义的危险因素采取相应措施预防与控制医院感染的发生,严格控制抗菌药物使用指征等对防止下呼吸道多重耐药非发酵菌感染非常重要。Objective To evaluate the drug resistance of three common non-fermentative bacteria1 healthcare-asso- ciated lower respiratory tract （LRT） infection in an intensive care unit（ICU）, and risk factors of multidrug resistant （MDR） non-fermentative bacterial infection. Methods Distribution and drug resistance of 182 non-fermentative iso- lates causing LRT in ICU patients from January, 2009 to December, 2010 were analyzed; risk factors for 91 cases infected with MDR non-fermentative bacteria were analyzed by Logistic regression analysis. Results The three most common non-fermentative bacteria were Pseudornonas aeruginosa （41. 36%, 79/191 ）, Acinetobacter baumannii （40. 32%,77/191）, and Stenotrophornonas maltophilia （ 13. 62%, 26/191）% drug-resistant rate of Acinetobacter baumannii to the third and fourth generation cephalosporins, quinolones, and aminoglycosides were up to above 80%//00; drug-resistant rate of Pseudornonas aeruginosa to imipenem was above 35%, to ceftriaxone and cefotaxime was up to more than 70% ; drug-resistant rate of Stenotrophomonas maltophilia to trimethoprim/sulfamethoxazole increased from 7. 14% in 2009 to 66. 67% in 2010（Z2 = 7. 66,P= 0. 00）, resistant rate to minoeyeline was 8. 33%. Duration of healthcare-associated infection （HAD 〉2 weeks（OR = 4. 53, P = 0. 03）, drug combination use 〉72 hours （OR = 3.51, P = 0. 03） were independent risk factors for MDR non-fermentative bacteria[ healthcare-associat- ed LRT infection （OR = 3. 51, P = 0. 03）. Conclusion Non-fermentative bacteria is the important pathogen in healthcare-associated LRT infection in 1CU, with high rate of drug resistance. It is important to prevent MI）R non- fermentative bacterial LRT infection by strict [imitation on the indication of ICU admission, proper measures accord-ing to risk factors, and strict control of antimicrobial agents.

关 键 词：医院感染 重症监护室 下呼吸道感染 非发酵菌 多重耐药菌 抗药性 微生物 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]