神经外科气管切开患者多重耐药菌感染的危险因素分析  

Analysis of risk factors for multi-drug resistant bacteria infection in patients with tracheotomy at department of neurosurgery

作　　者：汤颖[1] 胡阳琼[1] 肖灿[1] 罗嫩苗[1] 潘林香[1] TANG Ying HU Yang-qiong XIAO Can LUO Nen-miao PAN Lin- xiang(Department of Neurosurgery , 163 Hospital of PLA , Changsha 410003, China)

机构地区：[1]解放军第一六三医院神经外科,湖南长沙410003

出　　处：《实用医院临床杂志》2017年第4期81-84,共4页Practical Journal of Clinical Medicine

摘　　要：目的分析神经外科气管切开患者发生多重耐药菌感染的危险因素,为临床预防与治疗干预医院感染提供参考依据。方法选择2014年9月至2016年9月入住我院神经外科的气管切开患者216例,根据感染情况分为多重耐药菌(multiply drug-resistant bacteria,MDRB)感染组(全部多重耐药菌感染者)和非MDRB感染组(非多重耐药菌感染者)。采集痰标本进行培养、分离鉴定菌种,进行药敏试验,收集医院感染相关因素,分析其危险因素。结果本次共调查216名气管切开患者,发生多重耐药菌感染43例(19.9%)。43例患者中共检出病原菌68株,以革兰氏阴性杆菌为主。单因素分析显示:年龄、长期吸烟史、糖尿病史、意识障碍、气管切开时间、卧床时间、低白蛋白血症、联合使用广谱抗菌药物及机械通气时间,各组差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示:年龄、糖尿病史、意识障碍、气管切开时间、低白蛋白血症、联合使用广谱抗菌药物及机械通气时间是神经外科气管切开患者多重耐药菌感染的独立危险因素。结论神经外科气管切开患者容易发生革兰氏阴性杆菌为主的多重耐药菌感染,其危险因素包括,年龄、糖尿病史、意识障碍、气管切开时间、低白蛋白血症、联合使用广谱抗菌药物及机械通气时间等,在临床中需要采用集束化护理措施防治医院感染。Objective To analyze the risk factors of muhi-drug resistant bacteria infection in patients with tracheotomy at de- partment of neurosurgery in order to provide reference for clinical prevention and treatment of hospital infection. Methods Two hun- dred and sixteen patients with tracheotomy between September 2014 and September 2016 at our department were divided into MDRB group （multi-drug resistant bacteria infection） and NMDRB group （non multi-drug resistant bacteria infection）. Sputum samples were collected for culture, isolation and identification of bacteria strains. Drug sensitivity tests were carried out. Hospital infection related fac- tors were collected, and the risk factors were analyzed. Results There were 43 patients with multiple drug resistant bacteria infection （19. 9% ）. From the 43 patients ,68 strains of pathogenic bacteria were identified in which the main pathogens were gram-negative ba- cilli. Univariate analysis showed that there were significant differences in age, smoking history, diabetes, disturbance of consciousness, tracheotomy time, bedtime, hypoalbuminemia, combined use of broad-spectrum antibiotics and mechanical ventilation time between the two groups （P 〈0. 05）. Multivariate logistic regression analysis showed that age, diabetes, disturbance of consciousness, time of trache- otomy,hypoalbuminemia, combined use of broad-spectrum antibiotics and duration of mechanical ventilation were independent risk fac- tors of multi-drug resistant bacteria infection in these patients. Conclusion The patients with tracheotomy at department of neurosur- gery prone to multi-drug resistant bacteria infection, especially gram negative bacilli. Age, diabetes, disturbance of consciousness, time of tracheotomy, hypoalbuminemia, combined use of broad-spectrum antibiotics and duration of mechanical ventilation are independent risk factors of muhi-drug resistant bacteria infection in these patients. Cluster nursing should be taken to prevent and control the hospital in- fection.

关 键 词：神经外科 气管切开 医院感染 多重耐药菌 危险因素 

分 类 号：R473.6[医药卫生—护理学]