骨科创伤患者医院多药耐药菌感染危险因素logistic回归分析及预防对策  

Logistic regression analysis of risk factors for multidrug-resistant organisms infections trauma patients of orthopedics department

作　　者：黄冬红[1] 蒋云甫[1] 陈英[1] 陈城[1] 马锦虹[2] 王燕[3] HUANG Dong-hong JIANG Yun-fu CHEN Ying CHEN Cheng MA Jin-hong WANG Yan(Zhejiang Province Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 310008, China)

机构地区：[1]浙江省中医院骨伤科,浙江杭州310008 [2]浙江省中医院感染科,浙江杭州310008 [3]浙江省中医院护理部,浙江杭州310008

出　　处：《中华医院感染学杂志》2017年第5期1137-1140,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中医药管理局科技基金资助项目(2013ZB038)

摘　　要：目的 Logistic回归分析骨科创伤患者医院多药耐药菌感染危险因素,制定相关干预对策。方法分析2014年3月-2016年3月在医院骨科156例AB医院多药耐药菌感染创伤患者的多药耐药菌分布以及临床资料情况。结果 156例骨科创伤感染患者中,共分离出病原体174株,其中31株多药耐药菌,占17.8%。χ2检验单因素分析,骨科创伤感染患者发生多药耐药与住院时间、血清白蛋白、机械通气、抗菌药物使用时间、使用糖皮质激素、使用碳青霉烯类、合并糖尿病和使用3种及以上抗菌药物呈明显相关性(χ2=3.935、8.052、5.637、8.519、10.018、4.806、8.261及34.887,P<0.05);Logistic回归模型分析显示,血清白蛋白、使用糖皮质激素、使用3种及以上抗菌药物是骨科创伤感染患者发生多药耐药的独立危险因素(OR=4.891、4.442、8.541,P<0.05)。结论医院骨科创伤感染患者多药耐药现象较为严重,血清白蛋白、使用糖皮质激素、使用3种及以上抗菌药物是其发生的独立危险因素。OBJECTIVE To investigate the risk factors for multidrug-resistant organisms （MDROs） infections in trauma patients of orthopedics department through logistic regression analysis and put forward the related intervention countermeasures. METHODS A total of 156 trauma patients who had MDROs infections and were treated in the department of orthopedics from Mar 2014 to Mar 20]6 were enrolled in the study. The distribution of the MDROs and clinical data of the enrolled patients were observed. RESULTS Totally 174 strains of pathogens were i- solated from the 156 trauma patients with the infections, of which 31 were multidrug-resistant, accounting for 17.8%. The chi-square test univariate analysis showed that the incidence of the infections in the trauma patients of orthopedics department was significantly associated with length of hospital stay, serum albumin, mec.hanical venti- lation, time of use of antibiotics, use of glucocortieoids, use of carbapenems, complication with diabetic mellitus, and use of no less than three kinds of antibiotics （X2 = 3. 935, 8. 052, 5. 637, 8. 519, 10. 018, 4. 806, 8. 261, and 34. 887, P^0. 05）. The logistic regression model analysis indicated that the independent risk factors for the MDROs infections in the trauma patients of the orthopedics department included serum albumin, use of glucocorticolds, and use of no less than three kinds of antibiotics （0R=4. 891, 4. 442, 8. 541,P〈0.05）. CONCLUSION The pathogens isolated from the trauma patients with the infections of orthopedics department are highly multi- drug-resistant. The independent risk factors for the MDROs infections include the serum albumin, use of glucocorticoids, and use of no less than three kinds of antibiotics.

关 键 词：创伤 多药耐药 危险因素 

分 类 号：R378[医药卫生—病原生物学]