老年压疮创面多重耐药菌感染影响因素  

Risk factors of multi-drug resistant bacteria infection in elderly pressure ulcer wounds

作　　者：张萍 谢朝云 杨忠玲 ZHANG Ping;XIE Zhao-yun;YANG Zhong-ling(Inpatient Department of Qiannan People's Hospital,Duyun Guizhou 558000;Third Affiliated Hospital of Guizhou Medical University,China)

机构地区：[1]黔南州人民医院,贵州都匀558000 [2]贵州医科大学第三附属医院

出　　处：《中国消毒学杂志》2022年第12期937-940,共4页Chinese Journal of Disinfection

基　　金：贵州省科技厅联合项目(黔科合LH字[2014]7162号);贵州省黔南州社会发展科技项目(黔南科合社字[2018]7号)。

摘　　要：目的分析老年压疮患者创面多重耐药菌(MDRO)感染的病原菌分布及其影响因素。方法用回顾调查方法,对某三甲医院2011年2月—2020年12月老年压疮患者创面发生MDRO感染的风险进行分析,通过单因素、多因素logistic回归分析筛选出老年压疮患者创面MDRO感染的独立影响因素。结果老年压疮创面感染患者共258例,其中MDRO感染66例,占比25.58%;66例MDRO感染患者共培养出MDRO 71株,其中以超广谱β-内酰胺酶肠杆菌科细菌和耐甲氧西林金黄色葡萄球菌检出率较高,分别占29.58%和23.94%;从单因素分析与多因素logistic回归分析结果显示,类型(院内发生)、入住ICU、联用抗菌药物、血糖高是导致老年压疮创面MDRO感染独立危险因素,创面消毒换药次数(次/周)与更换床单次数是老年压疮创面MDRO感染独立保护因素。结论重点关注超广谱β-内酰胺酶肠杆菌科细菌和耐甲氧西林金黄色葡萄球菌,减少院内压疮发生,减少不必要入住ICU与联用抗菌药物,加强创面消毒换药,及时更换床单,控制血糖为主的综合措施,可减少老年压疮创面MDRO感染。Objective To analyze the distribution of pathogenic bacteria and its influencing factors of wound multi drug resistant bacteria(MDROs)infection in elderly patients with pressure ulcer.Methods Retrospective investigation was used to analyze whether MDROs infection occurred in the wound surface of elderly pressure ulcer patients in a third-class hospital from February 2011 to December 2020.The independent influencing factors of MDROs infection in the wound surface of elderly pressure ulcer patients were screened out by single factor and multi factor logistic regression analysis.Results There were 258 elderly patients with pressure ulcer wound infection,including 66 cases of MDROs infection,accounting for 25.58%.A total of 71 strains of MDROs were cultured from 66 patients infected with MDROs,of which ESBLs and MRSA were highly detected,accounting for 29.58%and 23.94%respectively.The results of univariate analysis and multivariate logistic regression analysis showed that type(occurring in hospital),admission to ICU,combined use of antibiotics,and blood glucose were independent risk factors for MDRO infection in elderly pressure ulcer wounds,and the times of wound disinfection and dressing change(times/week)and the times of bed sheet change were independent protective factors for MDRO infection in elderly pressure ulcer wounds.Conclusion Comprehensive measures focusing on reducing the incidence of pressure ulcer in hospital,reducing unnecessary admission to ICU and combined use of antibiotics,strengthening wound disinfection and dressing change,timely changing bed sheets,and controlling blood glucose can reduce MDROs infection in elderly pressure ulcer wounds.

关 键 词：老年 压疮创面 多重耐药菌 影响因素 LOGISTIC回归分析 

分 类 号：R111[医药卫生—公共卫生与预防医学] R378