危重症患者导管相关血流感染病原菌耐药性及影响因素分析  

Analysis of pathogenic bacterial resistance and influencing factors of catheter-related bloodstream infections in critically ill patients

作　　者：汪浩[1] 吉丽娟[1] 陈访 杨亚迪 张凤春[3] WANG Hao;JI Lijuan;CHEN Fang;YANG Yadi;ZHANG Fengchun(l.Departmentof Laboratory Medicine,Suzhou Jiulong Hospital,School of Medicine.Shanghai Jiao Tong University,Suzhou 215028.Jiangsu,China;Department of Critical Care Medicine,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiao Tong University;Department of Oncology,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiao Tong University)

机构地区：[1]上海交通大学医学院苏州九龙医院检验科,江苏苏州215028 [2]上海交通大学医学院苏州九龙医院重症医学科 [3]上海交通大学医学院苏州九龙医院肿瘤科

出　　处：《中国病原生物学杂志》2024年第1期88-91,共4页Journal of Pathogen Biology

基　　金：江苏省自然科学基金项目(No.BK20181186)。

摘　　要：目的分析危重症患者导管相关性血流感染(CRBSI)病原菌分布、耐药性及危险因素。方法选取2018年6月~2021年6月在本院综合ICU患者作为研究对象,统计患者感染率,分析感染患者的感染部位、病原菌分布及病原菌的耐药率,并采用SPSS22.0软件对感染的危险因素进行单因素及多因素logistic回归分析。结果1200例行中心静脉置管患者中有58例发生CRBSI感染,感染率为4.83%;58例感染患者共检查出37株病原菌,其中以革兰阳性菌为主,共25株占67.37%,革兰阴性菌12株占比32.63%。感染病原菌前三位的分别为金黄色葡萄球菌(10株,占27.03%)、表皮葡萄球菌(10株,占27.03%)和大肠埃希菌(6株,占16.22%)。革兰阳性菌中金黄色葡萄球菌对苯唑西林、红霉素、克林霉素有较高的耐药率,均≥50.00%;表皮葡萄球菌对苯唑西林、磺胺甲恶唑、庆大霉素有高耐药率,均≥30.00%;肠球菌属对苯唑西林、红霉素、环丙沙星有较高的耐药率,均≥60.00%。革兰阴性菌对环丙沙星、左氧氟沙星、美罗培南、亚胺培南等耐药率为0;其中鲍曼不动杆菌对10类抗菌药物耐药,铜绿假单胞菌对12类抗菌药物耐药。单因素分析结果显示,患者置管天数、合并糖尿病、气管切开为影响导管相关血流感染的可疑危险因素(χ^(2)=4.854、19.220、10.250,P<0.05)。经多元logistic回归分析结果显示,患者置管天数≥7 d(OR=0.333,95%CI:0.153~0.724)、合并糖尿病(OR=0.384,95%CI:0.162~0.912)、气管切开(OR=0.340,95%CI:0.156~0.740)是导管相关血流感染的独立危险因素(P<0.05)。结论根据患者相关症状进行有效的干预,完善医院感染监控管理系统,加强医护人员的无菌技术及防护措施,对ICU患者治疗和预防CRBSI都具有重要意义。Objective To analyze the distribution of pathogenic bacteria,drug resistance and risk factors of catheter-related bloodstream infections(CRBSI)in critically ill patients.Methods Patients in our comprehensive ICU from June 2018 to June 2021 were selected as the study subjects,and the infection rate of patients was counted,the infection site,distribution of pathogenic bacteria,and drug resistance rate of pathogenic bacteria in infected patients were analyzed,and single-factor and multifactorial logistic regression analyses of the risk factors of infections were performed by using SPSS22.0 software.Results CRBSI infection occurred in 58 of 1200 patients with central venous catheterization,with an infection rate of 4.83%;a total of 37 strains of pathogenic bacteria were examined in the 58 infected patients,of which 25 strains of gram-positive bacteria accounted for 67.37%,and 12 strains of gram-negative bacteria accounted for 32.63%.The top three infectious pathogens were Staphylococcus aureus(10 strains or 27.03%),Staphylococcus epidermidis(10 strains or 27.03%)and Escherichia coli(6 strains or 16.22%).Among the gram-positive bacteria,S.aureus had high resistance rates to benzoxacillin,erythromycin,and clindamycin,all≥50.00%;S.epidermidis had high resistance rates to benzoxacillin,sulfamethoxazole,and gentamicin,all≥30.00%;and Enterococcus spp.had high resistance rates to benzoxacillin,erythromycin,and ciprofloxacin,all≥60.00%.The resistance rate of Gram-negative bacteria to ciprofloxacin,levofloxacin,meropenem,and imipenem was 0;among them,Acinetobacter baumannii was resistant to 10 classes of antimicrobial drugs,and Pseudomonas aeruginosa was resistant to 12 classes of antimicrobial drugs.The results of univariate analysis showed that the number of days the patients were intubated,combined diabetes mellitus,and tracheotomy were the suspected risk factors affecting catheter-related bloodstream infections(χ^(2)=4.854,19.220,10.250,P<0.05).The results of multivariate logistic regression analysis showed that pa

关 键 词：危重症患者 导管相关血流感染 病原菌 药敏学 影响因素 

分 类 号：R459.7[医药卫生—急诊医学] R446.5[医药卫生—治疗学]