神经外科ICU患者多重耐药菌感染危险因素及其与TLR4基因多态性的关联  

Risk factors for multidrug-resistant organisms infections in neurosurgery intensive care unit patients and association with TLR4 gene polymorphisms

作　　者：单荣芳[1] 姜萍[2] 严红燕[3] 倪娟[3] 季建红[4] 蒋雅琼[4] 吴辉 SHAN Rong-fang;JIANG Ping;YAN Hong-yan;NI Juan;JI Jian-hong;JIANG Ya-qiong;WU Hui(The Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 22600l,China)

机构地区：[1]南通大学第二附属医院外科,江苏南通226001 [2]南通大学第二附属医院感控科,江苏南通226001 [3]南通大学第二附属医院神经外科,江苏南通226001 [4]南通大学第二附属医院重症监护室,江苏南通226001

出　　处：《中华医院感染学杂志》2023年第13期1981-1985,共5页Chinese Journal of Nosocomiology

基　　金：南通市市级科技计划(指导性)基金资助项目(MSZ19174,MSZ2022015)。

摘　　要：目的探讨神经外科重症监护室(ICU)患者多重耐药菌(MDRB)感染危险因素及其与Toll样受体4(TLR4)Thr399Ile基因多态性的关联。方法选取2020年3月-2021年5月南通大学第二附属医院收治的110例神经外科ICU患者为研究对象,按照是否发生MDRB感染分为研究组34例和对照组76例,比较两组TLR4 Thr399Ile基因型分布,分析MDRB感染情况,采用多因素回归分析影响神经外科ICU患者MDRB感染的危险因素。结果研究组TLR4 Thr399Ile位点T等位基因频率高于对照组,CC基因、C等位基因低于对照组(P<0.05);34例MDRB感染患者共分离MDRBs 41株,其中革兰阳性菌19株占比46.34%,革兰阴性菌22株占比53.66%;耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌对青霉素、红霉素、苯唑西林的耐药性较高,未发现对万古霉素、替加环素的耐药菌株。耐碳青霉烯类肺炎克雷伯菌和耐碳青霉烯类鲍氏不动杆菌对亚胺培南、美罗培南的耐药率较高,对四环素的耐药性较低;Logistic回归分析结果显示,入住ICU时间、机械通气时间、TLR4 Thr399Ile位点T基因均为影响神经外科ICU患者MDRB感染的危险因素。结论TLR4 Thr399Ile位点T基因是神经外科ICU患者MDRB感染的易感基因,临床可依据入住ICU时间>7 d、机械通气时间>7 d等高危因素制定预防措施。OBJECTIVE To explore the risk factors for multidrug-resistant organisms(MDROs)infections in neurosurgery intensive care unit(ICU)patients and analyze the association with Toll-like receptor 4(TLR4)Thr399lle gene polymorphisms.METHODS A total of 110 neurosurgery ICU patients who were treated in the Second Affiliated Hospital of Nantong University from Mar 2020 to May 2021 were recruited as the research subjects and were divided into the study group with 34 cases and the control group with 76 cases according to the status of MDROs infection.The genotypes of TLR4 Thr399lle were compared between the two groups,the incidence of MDROs infections was observed,and the multivariate regression analysis was performed for risk factors for the MDROs infections in the neurosurgery ICU patients.RESULTS The frequency of T allele at TLR4 Thr399lle locus of the study group was significantly higher than that of the control group,while the frequencies of CC genotypes and C allele of the study group were significantly lower than those of the control group(P<0.05).Totally 41 strains of MDROs were isolated from the 34 patients with MDROs infections,19(46.34%)of which were grampositive bacteria,and 22(53.66%)were gram-negative bacteria.Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus strains were highly resistant to penicillin,erythromycin and oxacillin,and no strains were found to be resistant to vancomycin and tigecycline.Carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii strains were highly resistant to imipenem and meropenem,while the drug resistance rates to tetracycline were low.The result of logistic regression analysis showed that length of ICU stay,mechanical ventilation duration and TLR4 Thr399lle locus T gene were the risk factors for MDROs infections in the neurosurgery ICU patients.CONCLUSION The TLR4 Thr399lle locus T gene is a susceptibility gene for MDROs infections in the neurosurgery ICU patients.It is necessary for the hosp

关 键 词：TOLL样受体4 神经外科 重症监护室 多重耐药菌 病原菌 危险因素 

分 类 号：R473.6[医药卫生—护理学]