呼吸重症监护病房下呼吸道感染病原菌种类、耐药状况及多重耐药菌感染危险因素分析  

Pathogen type, antimicrobial resistance and risk factors for multidrug-resistant pathogens in patients with lower respiratory tract infections managed in the respiratory intensive care unit

作　　者：刘玲[1] 赵弘卿[1] 王昕华[1] 许坤[1] 王洵[1] 

机构地区：[1]南京医科大学附属无锡市第二人民医院呼吸内科,江苏无锡市214002

出　　处：《热带病与寄生虫学》2015年第4期215-218,共4页Journal of Tropical Diseases and Parasitology

摘　　要：目的 调查呼吸重症监护病房（RICU）下呼吸道感染病原菌种类及耐药情况,探索引发多重耐药菌感染的危险因素,为制订预防和控制多重耐药菌感染措施提供参考依据。方法 收集2014年1~12月在无锡市第二人民医院RICU接受治疗的74例痰培养阳性下呼吸道感染病例作为研究对象,对引发下呼吸道感染的病原菌种类及其耐药情况进行调查,统计分析可能导致多重耐药菌感染的危险因素。结果 74例研究对象中分离出161株病原菌,占前4位的病原菌分别为金黄色葡萄球菌（23.60%）、肺炎克雷伯杆菌（20.50%）、鲍曼不动杆菌（16.15%）和铜绿假单胞菌（9.94%）。其中多重耐药菌106株（65.84%）,主要包括金黄色葡萄球菌（35.85%）、肺炎克雷伯杆菌（22.64%）、鲍曼不动杆菌（14.15%）等;泛耐药菌12株（7.45%）,主要为鲍曼不动杆菌（11株）和肺炎克雷伯杆菌（1株）。74例病例中有49例（66.22%）感染2种以上病原菌,其中合并耐甲氧西林金黄色葡萄球菌（MRSA）感染31例（41.89%）。Logistics回归分析显示,急性生理与慢性健康评分（APACHEⅡ）为多重耐药菌感染的独立危险因素。结论 RICU下呼吸道多重耐药菌感染发生率高,APACHEⅡ评分是多重耐药菌感染的独立危险因素。Objective To investigate the distribution of pathogens and antimicrobial resistance among patients with lower respiratory tract infections managed in respiratory intensive care unit（RICU）, and analyze the risk factors for multi-drug resistant pathogen infections for evidences to control and prevent the drug resis- tance. Methods A total of 74 patients with lower respiratory tract infections and positive sputum cultures, un- dergone treatment in the RICU in Wuxi No. 2 People＇s Hospital from January to December of 2014, were enrolled in the study. The distribution of pathogens inducing lower respiratory tract infections and antimicrobi- al resistance were investigated, and the risk factors for multi-drug resistant bacterial infections were identified and statistically analyzed. Results A total of 161 pathogens were isolated from the 74 subjects, and the top 4 pathogens included Staphylococcus aureus （23.60%）, Klebsiella pneumoniae （20.50%）, Acinetobacter baumannii （16.15%） and Pseudomonas aeruginosa （9.94%）. 106 strains of multi-drug resistant pathogens （65.84%） were identified, in which S. aureus （35.85%）, K. pneumoniae （22.64%） and A.baumannii （14.15%） were prominent. Twelve strains of pan-drug resistant pathogens （7.45%）were associated with A. baumannii （11 strains） and K. pneumoniae （1 strain）. Forty-nine of 74 patients （66.22%） were co-infected with at least two types of patho- gens, in whom 31 patients （41.89%） were co-infected with methicillin-resistant S. aureus. Logistic regression analysis indicated that Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ ） scoring was indepen- dent risk factor of multi-drug resistant bacterial infections. Conclusion Higher multi-drug resistant bacterial infections were observed in the patients with lower respiratory tract infections managed in RICU, and APACHE Ⅱ is an independent risk factor of multi-drug resistant bacterial infections.

关 键 词：呼吸重症监护病房 下呼吸道感染 多重耐药 危险因素 

分 类 号：R512.6[医药卫生—内科学]