重症颅脑损伤患者多药耐药菌感染病原学及危险因素  

Etiological characteristics and risk factors for multidrug-resistant organisms infections in patients with severe craniocerebral injury

作　　者：孙爽[1] 张雪[1] 刘漪漩 宋雨修 张春英 SUN Shuang;ZHANG Xue;LIU Yi-xuan;SONG Yu-xiu;ZHANG Chun-ying(Shengjing Hospital,China Medical University,Shenyang,Liaoning 110000,China)

机构地区：[1]中国医科大学附属盛京医院康复医学中心,辽宁沈阳110000

出　　处：《中华医院感染学杂志》2023年第6期871-874,共4页Chinese Journal of Nosocomiology

基　　金：辽宁省科研基金资助项目(2020H20110)。

摘　　要：目的 探讨重症颅脑损伤患者多药耐药菌感染病原学及危险因素。方法 选取2017年7月-2021年8月中国医科大学附属盛京医院重症康复病房收治的106例多药耐药菌感染重症颅脑损伤患者为研究组,另选取同期未发生多药耐药菌感染的重症颅脑损伤患者141例为对照组,回顾性分析研究组患者细菌培养及药敏试验结果,记录转归。结果 106例研究组患者中检测出病原菌171株,其中革兰阴性菌占比最多(70.76%),药敏试验分析发现鲍氏不动杆菌对头孢唑林、氨苄西林、头孢克洛、头孢呋辛、头孢美唑耐药率在85%以上;Logistic回归分析发现,机械通气时间、留置气管插管时间、抗菌药物使用时间是影响重症颅脑损伤多药耐药菌感染的危险因素(P<0.05);研究组炎症因子、CD_(3)^(+)、CD_(8)^(+)、CD_(19)^(+)水平均高于对照组,CD_(4)^(+)低于对照组(P<0.05);研究组治愈率低于对照组,病死率高于对照组(P<0.05)。结论 多药耐药菌感染重症颅脑损伤患者炎症反应加重,降低免疫功能及治愈率,治疗中需对机械通气时间、留置气管插管时间、抗菌药物使用时间进行干预或能改善疾病转归。OBJECTIVE To explore the etiological characteristics and risk factors for multidrug-resistant organisms(MDROs) infections in patients with severe craniocerebral injury. METHODS A total of 106 severe craniocerebral injury patients with MDROs infections who were treated in rehabilitation center of Shengjing Hospital, China Medical University from Jul 2017 to Aug 2021 were assigned as the study group, the clinical data were collected from the patients, meanwhile, 141 severe craniocerebral injury patients who did not have MDROs infections were chosen as the control group. The results of bacterial culture and drug susceptibility testing were retrospectively analyzed, and the treatment outcomes were recorded. RESULTS Totally 171 strains of pathogens were isolated from 106 patients of the study group, 70.76% of which were gram-negative bacteria. The result of drug susceptibility testing showed that the drug resistance rates of Acinetobacter baumannii strains to cefazolin, ampicillin, cefaclor, cefuroxime sodium and cefmetazole were more than 85%. Logistic regression analysis revealed that mechanical ventilation duration, endotracheal tube indwelling time and time of use of antibiotics were the risk factors for MDROs infections in the patients with severe craniocerebral injury(P<0.05). The levels of inflammatory factors, CD_(3)^(+), CD_(8)^(+)and CD_(19)^(+)of the study group were higher than those of the control group(P<0.05). The cure rate of the study group was lower than that of the control group, and the mortality rate of the study group was higher than that of the control group(P<0.05). CONCLUSION The severe craniocerebral injury patients with MDROs infections show severe inflammatory reactions, decline of immune function and low cure rate. It is necessary to take interventions to the mechanical ventilation duration, endotracheal tube indwelling time and time of use of antibiotics so as to improve the treatment outcomes.

关 键 词：多药耐药菌感染 重症颅脑损伤 病原菌 耐药性 转归 危险因素 

分 类 号：R651[医药卫生—外科学]