重症监护病房脑卒中相关性肺炎多重耐药菌感染的危险因素及病原学分析  

Risk factors and etiology of multiple drug-resistant bacterial infection of stroke-associated pneumonia patients in intensive care unit

作　　者：温德良[1] 李智博[1] 温艺超[1] 刘卫江[1] 熊旭明[1] 

机构地区：[1]广州医科大学附属第二医院重症医学科,广州市510260

出　　处：《实用医学杂志》2016年第13期2178-2181,共4页The Journal of Practical Medicine

摘　　要：目的：探讨重症监护病房（ICU）脑卒中相关性肺炎（SAP）患者发生多重耐药（MDR）菌感染的危险因素及病原菌的分布，为临床防治提供依据。方法：回顾性分析ICU2012年1月至2015年12月所有SAP患者的资料，x2检验比较各种因素SAP发生MDR菌感染差异，再选P〈0．05的因素进行多因素回归分析，分析MDR感染的危险因素和病原学分布。结果：352例脑卒中患者，发生SAP183例，分离出病原菌247株，其中MDR菌193株（78．1％），MDR前5位为：鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、大肠埃希杆菌；MDR感染与住ICU时间大于7d、严重意识障碍、晚发性肺炎和呼吸机通气时间大于7d4个因素有密切相关，差异有统计学意义（P〈0．05）：结论：MDR发生率较高。住ICU时间大于7d、严重意识障碍、晚发性肺炎和呼吸机通气时间大于7d是重症监护病房SAP发生MDR感染的高危因素．Ojective To determine the risk factors and the clinical distribution of multiple drug resistant bacteria in stroke- associated pneumonia （SAP） patients with multiple drug-resistant bacterial infections from in- tensive care unit, providing guidance for clinical treatment of SAP. Methods A retrospective study was de- signed to analyze the clinical data of the SAP patients from January 2012 to December 2015. Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections, and investigated the distribu- tion and drug resistance of MDR. Results There were 183 SAP patients, of which 131patients （71.6%） had MDR infection. There are 193 MDR strains in the 131 patients, the first 5 MDR strains were Acinetobacter bau- mannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Eseherichia coll. MDR in- fection is highly associated with sever unconsciousness, time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia and the difference was significant （P 〈 0.05）. Conclusion SAP patients with MDR bacterial infections are in association with the following risk factors： sever unconsciousness, time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia. The rate of MDR bacterial infections was high, and these MDR strains were widely different degrees of resistance to many antibiotics.

关 键 词：重症监护病房 卒中相关性肺炎 多重耐药菌 危险因素 病原学 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]