某综合医院常见多重耐药菌感染危险因素logistic回归分析  

Logistic regression analysis for risk factors of common multidrug-resistant organism infections in a general hospital

作　　者：陈国建 杨洁 邓艾 侯绍飞 邱永洁 徐世兰[2] CHEN Guojian;YANG Jie;DENG Ai;HOU Shaofei;QIU Yongjie;XU Shilan(Department of Infection Control,Chengdu Shangjin Nanfu Hospital,Chengdu,Sichuan 611730,P.R.China;Department of Infection Control,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]成都上锦南府医院医院感染管理科,成都611730 [2]四川大学华西医院医院感染管理部,成都610041

出　　处：《华西医学》2020年第3期290-295,共6页West China Medical Journal

摘　　要：目的分析多重耐药菌(mutidrug-resistant organism,MDRO)医院感染的危险因素,为MDRO医院感染防控提供科学依据。方法回顾性收集成都上锦南府医院2014年-2015年MDRO监测资料,将纳入患者分为MDRO医院感染组和MDRO非医院感染组。分析MDRO感染/定植情况、菌株种类、标本类型及临床科室分布等特点,并采用单因素及多因素logistic回归分析MDRO医院感染的危险因素。结果共监测MDRO感染/定植357例,其中MDRO医院感染147例次(144例),MDRO非医院感染213例次(213例)。MDRO医院感染发生率/例次发生率均为0.18%。共检出MDRO菌株371株,其中MDRO医院感染147株(39.62%),MDRO非医院感染224株(60.38%);MDRO非医院感染包括了社区感染175株(47.17%)和定植49株(13.12%)。检出的耐药菌以耐碳青霉烯类的鲍曼不动杆菌(52.83%)为主。标本分布以痰标本(57.14%)和分泌物标本(35.04%)为主。MDRO医院感染菌株科室分布前3位为骨科(32.65%)、ICU(27.89%)、神经外科(13.61%)。ICU[比值比(odds ratio,OR)=3.596,95%置信区间(confidence interval,CI)(1.124,11.501),P=0.031]、手术史[OR=2.858,95%CI(1.061,7.701),P=0.038]、留置尿管[OR=3.250,95%CI(1.025,10.306),P=0.045]、使用3种及以上的抗菌药物[OR=4.228,95%CI(1.488,12.011),P=0.007]是MDRO医院感染的独立危险因素。结论应针对MDRO医院感染的相关危险因素采取有效防控措施,降低MDRO医院感染发生率。Objective To analyze the risk factors of multidrug-resistant organism(MDRO)nosocomial infection,and to provide the scientific basis for the prevention and control of MDRO nosocomial infection.Methods Patients with MDRO in Chengdu Shangjin Nanfu Hospital from 2014 to 2015 were retrospectively collected.The patients were divided into the MDRO nosocomial infection group and the MDRO non-nosocomial infection group.The MDRO infection/colonization,bacterial strain type,specimens type and distribution characteristics of clinical departments were analyzed.Single factor and multiple factor logistic regression analysis were used to analyze the risk factors of MDRO nosocomial infection.Results A total of 357 patients of MDRO infection/colonization were monitored,of which 147 times(144 patients)were with nosocomial infections and 213 times(213 patients)were without nosocomial infections.MDRO nosocomial infection incidence rate/cases incidence rate were 0.18%.A total of 371 MDRO bacterial strains were detected,of which 147(39.62%)were with nosocomial infection and 224(60.38%)were without nosocomial infections.The MDRO non-nosocomial infections included 175 strains(47.17%)in community infection and 49 strains(13.12%)in colonization.Carbapenem-resistant Acinetobacter baumannii(52.83%)was the main MDRO strains.Sputum(57.14%)and secretion(35.04%)were main specimens.The top three departments of MDRO nosocomial infection strains were orthopedics(32.65%),ICU(27.89%),neurosurgery(13.61%).ICU[odds ratio(OR)=3.596,95%confidence interval(CI)(1.124,11.501),P=0.031],surgical history[OR=2.858,95%CI(1.061,7.701),P=0.038],indwelling urinary catheter[OR=3.250,95%CI(1.025,10.306),P=0.045],and using three or more antibiotics[OR=4.228,95%CI(1.488,12.011),P=0.007]were the independent risk factors of MDRO nosocomial infection.Conclusion Effective infection prevention and control measures should be adopted for the risk factors of MDRO nosocomial infection to reduce the incidence rate of MDRO nosocomial infection.

关 键 词：综合医院 多重耐药菌 危险因素 LOGISTIC回归分析 

分 类 号：R446.5[医药卫生—诊断学]