ICU多药耐药菌感染现状与危险因素分析  

Infection status and risk factors of multidrug-resistant organisms in intensive care unit

作　　者：李福琴[1] 杨阳[1] 刘彩红[1] 湛玉晓 冯亚静[1] 

机构地区：[1]郑州大学第一附属医院感染管理科,河南郑州450052

出　　处：《中华医院感染学杂志》2016年第4期783-785,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫计委医学科技攻关基金资助项目(201403039)

摘　　要：目的了解重症监护病房(ICU)住院患者感染多药耐药菌(MDROs)的分布特征,并分析MDROs感染相关危险因素,为其预防与控制工作提供参考依据。方法对医院2014年1月-2015年1月ICU收治的17 659例患者进行目标性监测,分析MDROs感染率及分布,采用法国生物梅里埃公司VITEK系统对病原菌进行鉴定及药敏试验,依据美国临床和实验室标准化研究所(CLSI)标准对结果进行判定;采用多因素非条件logistic回归分析MDROs感染的相关危险因素。结果 17 659例ICU住院患者中发生MDROs感染1 939例,感染率为10.98%,主要来源为社区获得性感染;MDROs感染率较高的科室为呼吸科ICU、综合ICU和外科ICU,分别为24.34%、17.84%和17.68%;共分离出5 165株病原菌,其中MDROs有2 418株,检出率为46.82%,MDROs检出率较高的为鲍氏不动杆菌、金黄色葡萄球菌和大肠埃希菌,分别为61.93%、56.81%、42.81%;多因素非条件logistic回归分析显示,住院时间、呼吸机使用时间、中心静脉插管时间和基础疾病是ICU MDROs感染的独立危险因素。结论 ICU患者MDROs的感染率及检出率较高,鲍氏不动杆菌为最主要的MDROs;ICU患者MDROs感染的危险因素为住院时间、呼吸机使用时间、中心静脉插管时间和基础疾病。OBJECTIVE To investigate the infection situation,distribution characteristics and risk factors of multidrug-resistant organisms（MDROs）in intensive care unit（ICU）,and thereby provide the reference basis and effective strategies for the prevention and control of multidrug-resistant organism infection.METHODS Totally17 659 patients in the ICU who received objective surveillance in the hospital from Jan.2014 to Jan.2015 were enrolled in the study.The distribution characteristics and the infection rate of multidrug-resistant organisms were investigated.The VITEK system（Bio-merieux,France）was used for pathogenic identification and drug sensitivity test and the results were interpreted according to CLSI criteria.Meanwhile,risk factors of MDROs infection were analyzed by multi-factor unconditioned logistic regression.RESULTS The total number of patients was 17 659 in ICU,the case number of patients infected by MDROs were 1 939（10.98%）,which were mainly community acquired infection.The infection rates of MDROs were higher in departments such as respiratory intensive care unit（24.34%）,comprehensive intensive care unit（17.84%）,and surgical intensive care unit（17.68%）,respectively.A total of 5 165 pathogenic bacteria strains were isolated,the number of the MDROs strains were 2 418（46.82%）.The MDROs of higher detection rates were Acinetobacter baumannii（61.93%）,Staphylococcus aureus（56.81%）,and Escherichia coli（42.81%）,respectively.Multi-factor unconditioned logistic regression analysis showed that the risk factors for MDROs infection in ICU included hospital stays,mechanical ventilation time,central venous catheter time,and underlying diseases.CONCLUSION There is a high level both in MDROs infection rates and MDROs detection rates for patients in ICU.A.baumannii is the major MDROs which lead to infection in ICU.Hospital stays,mechanical ventilation time,central venous catheter time,and underlying diseases are closely related with MDROs infection.

关 键 词：重症监护病房 多药耐药菌 感染 危险因素 

分 类 号：R378[医药卫生—病原生物学]