MICU病原菌分布及泛耐药菌感染危险因素分析  

Distribution of pathogens in MICU and risk factors for pandrug-resistant bacteria infections

作　　者：宋世平[1] 李艳[1] 陈建魁[1] 尹秀云[1] 王淼[1] 于农[1] 杨倩林[1] 金欣[1] 

机构地区：[1]军事医学科学院附属医院检验科,北京100071

出　　处：《中华医院感染学杂志》2012年第17期3715-3717,3735,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解综合医院内科重症监护病房病原菌分布及泛耐药菌医院感染相关危险因素。方法 2010年1至12月内科重症监护病房收治的266例患者临床标本中分离菌株673株,经VITEK-2微生物鉴定系统鉴定;回顾性分析资料完整的泛耐药菌感染病例60例,1∶1病例对照研究,logistic多因素回归分析筛选出泛耐药菌医院感染的危险因素。结果分离的673株病原菌中,645株来源于呼吸道标本,其次来源于尿、血、皮肤创口脓液;338株为革兰阴性杆菌,包括非发酵革兰阴性菌37.9%,肠杆菌科细菌7.4%;其次是真菌210株,均为假丝酵母菌属;革兰阳性菌125株,占18.6%,包括葡萄球菌属11.4%、肠球菌属3.7%;泛耐药菌感染的独立危险因素为有创机械通气(OR=14.820)、住院时间>30d(OR=9.269)及应用碳青霉烯类抗菌药物(OR=4.857)。结论内科重症监护病房病原菌以革兰阴性菌为主,非发酵菌多于肠杆菌科细菌;其次是真菌和革兰阳性球菌,假丝酵母菌多于革兰阳性球菌,屎肠球菌多于粪肠球菌;降低危险因素有助于预防和控制泛耐药菌引起的医院感染。OBJECTIVE To investigate the etiology distribution and relevant risk factors of nosocomial infections caused by pandrug-resistant bacteria in medical intensive care unit（MICU） of a general hospital.METHODS A total of 673 strains isolated from clinical samples of 266 patients in MICU from Jan to Dec 2010 were identified with automatic microorganism analysis system Vitek-2.Sixty cases with complete clinical data were retrospectively analyzed,then by the means of case-control study in a 1：1 ratio,the risk factors for nosocomial infections caused by pandrug-resistant bacteria were screened by logistic regression analysis.RESULTS Of 673 isolates,645 strains came from the respiratory tract,the others from urine,blood and pus of skin wounds;there were 338 strains of gram-negtive bacilli,including non-fermenting gram-negative bacilli（37.9%） and Enterobacteriaceae（7.4%）;following was the 20 strains of fungi which were all Candida;there were 125（18.6%） strains of gram-positive bacteria,including Staphylococci（11.4%） and Enterococci（3.7%）;the independent risk factors leading to the infections of pan-drug resistant bacteria were invasive mechanical ventilation（OR=14.820）,hospital stay with more than 30 days（OR=9.269） and the use of carbapenems（OR=4.857）.CONCLUSION The pathogens in MICU are dominated by gram-negative bacteria,non-fermenting bacteria are more than Enterobacteriaceae;following is the fungi and gram-positive cocci,Candida are more than gram-positive cocci,and Enterococcus faecium is more than Enterococcus faecalis;reducing the related risk factors may contribute to the prevention and control of nosocomial infections caused by pandrug-resistant bacteria.

关 键 词：重症监护病房 泛耐药菌 医院感染 危险因素 

分 类 号：R181.32[医药卫生—流行病学]