ICU是多重耐药鲍曼不动杆菌下呼吸道医院感染的高危场所  

ICU is a high-risk unit for healthcare-associated lower respiratory tract infection caused by multidrug-resistant Acinetobacter baumannii

作　　者：王黎一[1] 史利克[1] 王悦[1] WANG Li-yi;SHI Li-ke;WANG Yue(Department of Infection Control, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China)

机构地区：[1]河北医科大学第二医院感染控制处

出　　处：《中国感染控制杂志》2019年第8期725-731,共7页Chinese Journal of Infection Control

基　　金：2018年度河北省医学科学研究重点课题计划项目(20180356)

摘　　要：目的探讨在感染预防与控制措施落实到位的情况下,重症监护病房(ICU)是否仍为多重耐药鲍曼不动杆菌(MDR-AB)下呼吸道医院感染发生的高危单元。方法调查2017年8月-2018年8月某院本部确诊为鲍曼不动杆菌(AB)下呼吸道医院感染病例,其中MDR-AB感染患者为病例组,以性别、年龄±2岁作为匹配因素,采用1∶1个体匹配病例对照,并筛选同期非MDR-AB感染患者作为对照组,再用logistic回归控制其他混杂因素,探讨ICU是否仍为MDR-AB下呼吸道医院感染发生的高危单元。同时调查同期ICU与普通病房医护人员手卫生相关情况并比较。结果共有227例确诊为AB下呼吸道医院感染患者,其中MDR-AB感染66例,非MDR-AB感染161例。采用1∶1个体匹配后,对照组患者感染前二联抗菌药物使用日数、导尿管留置日数和中心静脉置管日数均高于病例组(均P<0.05);病例组患者感染前ICU入住率、中心静脉导管留置率和导尿管留置率均高于对照组(均P<0.05);logistic回归分析显示,入住ICU和和留置导尿管是患者发生MDR-AB下呼吸道医院感染的独立危险因素(均P<0.05)。病例组与对照组患者检出的AB对头孢呋辛/舒巴坦的耐药率均>90%,对多粘菌素B的敏感率均为100%。医护人员手卫生依从率为ICU(86.96%)高于普通病房(71.94%),差异有统计学意义(P<0.05)。ICU医护人员手卫生知识知晓率(90.77%)也高于普通病房(84.47%),差异有统计学意义(P<0.05)。结论 ICU是MDR-AB下呼吸道医院感染发生的高危场所,留置导尿管患者为MDR-AB感染的高发人群。Objective To investigate whether the intensive care unit(ICU)is still a high-risk unit for healthcareassociated lower respiratory tract infection(HA-LRTI)caused by multidrug-resistant Acinetobacter baumannii(MDR-AB)when infection prevention and control measures are implemented.Methods HA-LRTI caused by AB in a hospital from August 2017 to August 2018 were investigated,patients with MDR-AB infection were selected as case group,with sex and age±2 years old as matching factors,a1∶1 matched case-control study was adopted,patients without MDR-AB infection during the same period were selected as control group,logistic regression was used to control other confounding factors,whether ICU was still a high-risk unit for MDR-AB HA-LRTI was explored.Hand hygiene of health care workers(HCWs)in ICU and general wards during the same period was investigated and compared.Results A total of 227 patients confirmed with HA-LRTI caused by AB,including 66 cases of MDR-AB infection and 161 cases of non-MDR-AB infection.After 1∶1 matching,binary antimicrobial use before infection,urinary catheterization days and central venous catheterization day in petients in control group were all higher than those in case group(all P<0.05);ICU occupancy rate,central venous catheterization rate and urinary catheterization rate in patients in case group before infection were all higher than those in control group(all P<0.05);logistic regression analysis showed that ICU stay and urinary catheterization were independent risk factors for MDR-AB HA-LRTI(both P<0.05).Resistance rates of AB to cefuroxime/sulbactam in patients in case group and control group were both>90%,and the sensitivity rates to polymyxin B were all 100%.Hand hygiene compliance rate of HCWs in ICU was higher than that in general wards(86.96%vs 71.94%,P<0.05).The awareness rate of hand hygiene knowledge of HCWs in ICU was also higher than that of general wards(90.77% vs 84.47%,P<0.05).Conclusion ICU is a high-risk unit for MDR-AB HA-LRTI,patients with urinary catheterization are the

关 键 词：鲍曼不动杆菌 下呼吸道感染 多重耐药菌 医院感染 重症监护病房 匹配 病例对照 

分 类 号：R181.32[医药卫生—流行病学]