神经康复病房肺部多重耐药菌感染的病原学特点及影响因素分析  

Etiological characteristics and influencing factors of pulmonary infection caused by multidrug-resistant bacteria infection in neurological rehabilitation wards

作　　者：蒋玮[1] 谭波涛[1] 文思阳 李浪[1] 宋云玲 虞乐华[1] 贾朗[1] JIANG Wei;TAN Botao;WEN Siyang;LI Lang;SONG Yunling;YU Lehua;JIA Lang(Department of Rehabilitation Medical Division,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Clinical Laboratory Division,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院康复医学科,重庆400010 [2]重庆医科大学附属第二医院检验科,重庆400010

出　　处：《重庆医学》2023年第4期497-501,共5页Chongqing medicine

基　　金：国家自然科学基金项目(82002377);重庆市科卫联合项目(2020MSXM116);重庆医科大学附属第二医院“宽仁英才”项目。

摘　　要：目的分析神经康复病房多重耐药菌感染的病原学特点和危险因素。方法选取2016年6月至2020年6月该院收治的427例并发肺部感染患者作为研究对象,回顾性分析多重耐药菌的病原学特点。采用logistic回归分析相关危险因素。结果剔除掉重复菌株后,从79例患者中检出95株多重耐药菌,其中革兰氏阴性菌91株(占95.79%),主要包括鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯肺炎亚种,其对大多数抗菌药物耐药,但对头孢哌酮/舒巴坦、替加环素敏感度较高。多因素回归分析结果显示,气管切开[比值比(OR)=5.348,95%置信区间(95%CI)=2.094~13.662,P<0.05]、清蛋白<40 g/L(OR=2.311,95%CI=1.241~4.301,P<0.05)、抗菌药物使用时间>7 d(OR=9.405,95%CI=4.545~19.460,P<0.05)是神经康复病房患者发生多重耐药菌感染的危险因素。结论神经康复病房多重耐药菌感染以革兰氏阴性菌为主,多重耐药菌感染的发生与低蛋白血症、气管切开、抗菌药物使用时间长等因素有关。Objective To analyze the etiological characteristics and risk factors of multidrug-resistant bacteria infection in neurological rehabilitation wards.Methods From June 2016 to June 2020,a total of 427 patients complicated with pulmonary infection were selected as the research objects,and the etiological characteristics of multidrug-resistant bacteria were analyzed retrospectively.Logistic regression was used to analyze the related risk factors.Results After eliminating the repetitive strains,95 strains of multidrug-resistant bacteria were detected from 79 patients,among which 91 strains were Gram-negative bacteria(95.79%),mainly including Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae.They were resistant to most antibacterial drugs,but were highly sensitive to cephalosporidone/schumatin and tigecycline.Multivariate regression analysis showed that tracheotomy(OR=5.348,95%CI=2.094-13.662,P<0.05),the protein<40 g/L(OR=2.311,95%CI=1.241-4.301,P<0.05),the use time of antibacterial drugs>7 days(OR=9.405,95%CI=4.545-19.460,P<0.05)were the risk factors for patients with multidrug-resistant pulmonary infection in the neurological rehabilitation wards.Conclusion Gram-negative bacteria are the main infections of multidrug-resistant bacteria in neurological rehabilitation wards,and the occurrence of multidrug-resistant bacteria infections is related to factors such as hypoproteinemia,tracheotomy and long-term use of antibacterial drugs.

关 键 词：康复 多重耐药菌 感染 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]