重症监护病房鲍氏不动杆菌致呼吸机相关性肺炎的危险因素分析及干预对策  

Risk factors analysis of ventilator-associated pneumonia patients infected with Acinetobacter baumannii in ICU and its preventive measures

作　　者：张琼[1] 曾莉[2] 毛方菊[3] 樊宏英[4] 任艳蕊[1] 

机构地区：[1]荆州市第一人民医院护理部,湖北荆州434000 [2]荆州市第一人民医院ICU,湖北荆州434000 [3]荆州市第一人民医院NCU,湖北荆州434000 [4]荆州市第一人民医院院感办,湖北荆州434000

出　　处：《中华医院感染学杂志》2017年第3期554-557,共4页Chinese Journal of Nosocomiology

基　　金：湖北省卫生计生委医药院校专项基金资助项目(WJ20216-Y-31)

摘　　要：目的多元回归分析重症监护病房(ICU)鲍氏不动杆菌(ABA)致呼吸机相关性肺炎的危险因素,制定相关干预对策。方法选择2013年3月-2016年3月医院ICU治疗ABA致呼吸机相关性肺炎患者126例进行研究,统计感染ABA的药敏性,并分析ICU ABA致呼吸机相关性肺炎发生的危险因素,进行统计分析。结果ABA对氨苄西林、庆大霉素的耐药率较高达90.00%以上,对亚胺培南和美罗培南最为敏感,耐药率均<20.00%,其中85株ABA显示对≥3种抗菌药物耐药为泛耐药;单因素分析显示,ICU泛耐药ABA呼吸机相关性肺炎的发生与住院时间、机械通气方式、使用糖皮质激素、留置胃管、使用碳青霉烯类抗菌药物及使用≥3种抗菌药物呈明显相关性(χ2=20.292、10.414、7.524、7.810、9.760和11.635,P<0.05);logistic回归模型分析显示,机械通气方式、留置胃管、使用≥3种抗菌药物是ICU泛耐药ABA呼吸机相关性肺炎发生的独立危险因素(OR=6.527、6.337、5.467,P<0.05)。结论 ICU呼吸机相关性肺炎ABA泛耐药现象严重,机械通气方式、留置胃管、使用≥3种抗菌药物是其发生的独立危险因素,医护人员应避免ABA感染和耐药的进一步传播。OBJECTIVE To analyze the risk factors of ventilator-associated pneumonia patients infected with Acinetobacter baumannii（ABA）in ICU by multiple regression analysis,and formulate preventive measures.METHODS From Mar.2013 to Mar.2016,drug sensitivity and risk factors of 126 cases of ventilator-associated pneumonia patients infected with AB in ICU were analyzed retrospectively.RESULTS AB showed high resistant rates to ampicillin and gentamicin,and the resistant rates were more than 90%,and high sensitivity to imipenem and meropenem,and the resistant rates were lower than 20%.Among these,85 cases showed 3or more kinds of antibiotics resistance and classified as pan-resistance.Single factor analysis showed that hospital stay,mechanical ventilation mode,the use of corticosteroids,indwelling stomach tube,the use of carbapenem antibiotics and using three or more kinds of antibiotics were significantly correlated with the development of pan-resistance of AB in ventilatorassociated pneumonia patients（χ2=20.292,10.414,7.524,7.810,9.760 and 11.635,P〈0.05）.Logistic regression model analysis showed that mechanical ventilation,indwelling tube,and using three or more kinds of antibiotics were independent risk factors of pan-resistance of AB in ventilator-associated pneumonia patients（OR=6.527,6.337,and 5.467,P〈0.05）.CONCLUSIONPan-resistance of AB is serious in ventilator-associated pneumonia patients of ICU,and mechanical ventilation,indwelling tube,and using three or more kinds of antibiotics are the independent risk factors.Medical staff should avoid the further spread of infections and drug resistance of ABA.

关 键 词：重症监护病房 鲍氏不动杆菌 呼吸机相关性肺炎 

分 类 号：R378[医药卫生—病原生物学]