ICU病房下呼吸道多药耐药鲍曼不动杆菌感染高危因素、耐药性及预防措施研究  

RISK FACTORS,DRUG RESISTANCE AND PREVENTIVE MEASURES OF CRAB INFECTION IN THE LOWER RESPIRATORY TRACT IN ICU WARD

作　　者：黄剑林[1] 陈维贤[2] 

机构地区：[1]广西北海市人民医院ICU,536000 [2]重庆医科大学附属第二医院检验科

出　　处：《中国煤炭工业医学杂志》2016年第9期1257-1260,共4页Chinese Journal of Coal Industry Medicine

基　　金：国家"十二五"科学技术重大专项基金资助项目(编号:2012ZX10004212003)

摘　　要：目的分析ICU病房下呼吸道多药耐药鲍曼不动杆菌(CRAB)感染高危因素、耐药性及预防措施。方法分别选取2012年7月—2015年8月该院ICU病房接受治疗的患者420例,发生下呼吸道多药耐药CRAB感染(观察组)的210例,未发生(对照组)的210例;对患者各方面资料进行统计记录,分析下呼吸道多药耐药CRAB感染高危因素;对观察组痰液进行药敏实验,了解下呼吸道多药耐药CRAB感染耐药性;根据研究结果总结下呼吸道多药耐药CRAB感染预防措施。结果二组慢性肺病、APACHEⅡ评分、氟喹诺酮、亚胺培南、早期抗生素联用比较差异有统计学意义(P<0.05),提示ICU病房下呼吸道多药耐药CRAB感染与这些因素密切相关;多因素分析结果显示,氟喹诺酮、亚胺培南、早期抗生素联用为ICU病房下呼吸道多药耐药CRAB感染单高危因素;痰标本药敏实验结果显示,除氨苄西林-舒巴坦、亚胺培南中度敏感,左氧氟沙星不敏感外,其他抗菌药物均显示耐药。结论基础疾病严重、侵入性操作较多、早期抗生素联用是引起下呼吸道多药耐药CRAB感染的高危因素,应引起重视。同时,该感染患者具有多药耐药性,临床治疗时还应注意合理用药。Objective To analyze the risk factors,drug resistance,and the preventive measures of the drug resistance of the lower respiratory tract drug resistance in ICU ward.Methods We selected420 cases from July 2012 to August 2015 accepted the treatment in the intensive care unit（ICU）of author＇s hospital with210 cases in each group,the former occured lower respiratory tract multidrug resistance of CRAB infection（study group）,the latter did not occur（control group）.On all aspects of patient data were recorded by questionnaires and follow-up,to analyze the multidrug resistance of CRAB and infection risk factors of lower respiratory tract.By drug sensitivity test of sputum in the study group,we understood the drug resistance of lower respiratory tract infection of multidrug resistance of CRAB.According to the research results,multidrug resistance of CRAB infection prevention measures was summarized in the lower respiratory tract.Results Two groups of chronic lung disease,APACHE II score,quinolone and imipenem/meropenem,early antibiotic combined with difference was significant（P〈0.05）,prompting ICU lower respiratory tract multidrug resistance of CRAB infection was closely related to these factors.Multivariate analysis showed that the fluorine quinolone and imipenem/meropenem,early antibiotic combined with ICU respiratory multidrug-resistant A baumannii Acinetobacter infection risk factors.Sputum susceptibility test results showed that：in addition to ampicillin sulbactam and imipenem/meropenem moderately sensitive to levofloxacin was not sensitive to outside,other antibiotics showed resistance.Conclusions The high risk factors of the infection of the lower respiratory tract are much more,such as Bauman,a high risk factor,should be paid more attention.At the same time,the infection of patients with multiple drug resistance,clinical treatment should pay attention to the rational use of drugs.

关 键 词：多药耐药 鲍曼不动杆菌 ICU 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]