ICU患者多药耐药菌感染的影响因素分析  

Influencing factors for multidrug-resistant organisms infection in ICU patients

作　　者：黄文婷[1] 吴培玉[1] 黄慧雅[1] 赖开兰[1] HUANG Wen-ting;WU Pei-yu;HUANG Hui-yan;LAI Kai-Ian(The Fifth Hospital Affiliated to Zhongshan University,Zhuhai»Guangdong 519000,China)

机构地区：[1]中山大学附属第五医院急诊医学科

出　　处：《中华医院感染学杂志》2019年第21期3246-3250,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81701871)

摘　　要：目的分析重症监护病房(ICU)患者发生多药耐药菌感染影响因素。方法选取中山大学附属第五医院2016年1月-2017年12月治疗的发生耐药菌感染的ICU患者303例。观察患者发生感染的病原菌分布,主要病原菌耐药性,并经药敏试验将所有患者分为多药耐药菌感染组(187例)和非多药耐药菌感染组(116例),分析引发多重感染的影响因素。结果303例发生感染患者共检出446株病原菌,以鲍氏不动杆菌为主,为80株(17.94%)。铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶的耐药性最高,鲍氏不动杆菌对头孢噻肟、哌拉西林耐药性最高,肺炎克雷伯菌对头孢噻肟的耐药性最高,金黄色葡萄球菌对庆大霉素耐药性最高,大肠埃希菌对磺胺甲噁唑/甲氧苄啶耐药性最高。其中,留置胃管时间、留置导尿管时间、住院时间、深静脉置管时间、抗菌药物种类、深静脉置管时间、机械通气时间>48 h等因素构成多药耐药菌感染的影响因素。经Logistic回归分析,留置胃管时间、留置导尿管时间、住院时间、深静脉置管时间、抗菌药物种类、机械通气时间>48 h均为引发多药耐药菌感染的独立影响因素。结论ICU患者多药耐药菌感染发生率高,需从用药、治疗、护理等方面进行有效的指导及监督,以减少其感染的发生率。OBJECTIVE To analyze the influencing factors for multidrug-resistant organisms(MDROs)infections in intensive care unit(ICU)patients.METHODS A total of 303 ICU patients with drug-resistant bacteria infection who were treated in The Fifth Hospital Affiliated to Zhongshan University from Jan 2016 to Dec 2017 were enrolled in the study.The distribution of pathogens causing the infection was observed,the drug resistance rates of major species of pathogens were analyzed,the enrolled patients were divided into the MDROs infection group with 187 cases and the non-MDROs infection group with 116 cases according to the result of drug susceptibility testing,and the influencing factors for the MDROs infection were analyzed.RESULTS Totally 446 strains of pathogens were isolated from the 303 patients with infection,80(17.94%)of which were Acinetobacter baumannii.The drug resistance rate of Pseudomonas aeruginosa strains to sulfamethoxazole-trimethoprim was the highest;the drug resistance rates of A.baumannii strains to cefotaxime and piperacillin were the highest;the drug resistance rate of Staphylococcus aureus strains to gentamicin was the highest;the drug resistance rate of Escherichia coli strains to sulfamethoxazole-trimethoprim was the highest.The influencing factors for the MDROs infection included gastric tube indwelling time,urinary catheter indwelling time,length of hospital stay,types of antibiotic,deep venous catheter and more than 48 hours of mechanical ventilation.Logistic regression analysis showed that the gastric tube indwelling time,urinary catheter indwelling time,length of hospital stay,deep venous catheter indwelling time,types of antibiotics and more than 48 hours of mechanical ventilation were the independent influencing factors for the MDROs infection.CONCLUSION The incidence rate of MDROs infection is high among the ICU patients,and it is necessary to conduct effective guidance and supervision for use of antibiotics,treatment and nursing so as to reduce the incidence of infection.

关 键 词：ICU患者 多药耐药菌感染 影响因素 预防对策 

分 类 号：R378[医药卫生—病原生物学]