神经外科昏迷促醒患者多重耐药菌感染病原菌情况及相关影响因素  

Pathogenic Bacteria of Multidrug-Resistant Organisms Infection and Related Factors in Coma-Promoted A wakening Patients in Neurosurgical

作　　者：丁雅琼[1] 刘亚柯 侯慧峰[1] 张胜勇 DING Yaqiong;LIU Yake;HOU Huifeng;ZHANG Shengyong(Department of Infection Prevention and Control,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450001,China;Department of Clinical Laboratory,Public People’s Hospital of Xinzheng(Xinzheng Branch Zhengzhou Central Hospital),Zhengzhou 451100,China)

机构地区：[1]郑州大学附属郑州市中心医院感染预防控制科,河南郑州450001 [2]新郑市公立人民医院(郑州市中心医院新郑分院)检验科,河南郑州451100

出　　处：《河南医学研究》2024年第2期240-244,共5页Henan Medical Research

基　　金：国家科技重大专项(2018ZX10713003-002-003)。

摘　　要：目的调查神经外科昏迷促醒中心患者多重耐药菌(MDRO)感染病原菌情况,构建logistic回归模型进一步分析其影响因素。方法选取2021年5月至2022年12月医院收治的神经外科昏迷促醒中心211例患者为研究对象,采集患者痰标本进行病原菌培养与药敏试验,统计病原菌检出情况及耐药率,根据是否发生MDRO分为观察组(是)和对照组(否),采用logistic回归方程分析昏迷促醒患者发生MDRO的影响因素。结果211例调查对象痰标本共检出病原菌285株,其中有130例发生MDRO,共188株,耐药率为65.96%(188/285),产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌、耐碳青霉烯类抗菌药物鲍曼不动杆菌(CR-AB)、耐甲氧西林金黄色葡萄球菌(MRSA)占比分别为54.26%、32.98%、12.77%。两组年龄、机械通气时间、血糖水平、联合使用抗菌药物、美国国立卫生研究院卒中量表(NIHSS)评分、营养风险比较,差异有统计学意义(P<0.05)。年龄、机械通气时间、血糖水平、联合使用抗菌药物、NIHSS评分、营养风险是MDRO发生的危险因素(P<0.05)。结论年龄、机械通气时间、血糖水平、联合使用抗菌药物、NIHSS评分、营养风险是诱发MDRO的危险因素,建议临床采取集束化护理措施防止医院感染。Objective To investigate the pathogenic bacteria of multidrug-resistant organisms(MDRO)infections in patients of the neurosurgical coma-promotion center,and construct a logistic regression model to further analyze the influencing factors,aiming to provide a scientific basis for clinical formulation of preventive and intervention measures.Methods From May 2021 to December 2022,211 patients admitted to the neurosurgical coma promotion center in hospital were used as study subjects.Sputum specimens were collected for pathogenic bacteria culture and drug sensitivity test,and the pathogenic bacteria detection and drug resistance rate were counted.According to whether MDRO,the patients were divided into observation group(yes)and control group(no).Logistic regression equations were used to analyze the factors that influenced the occurrence of MDRO in patients with coma and awakening,and logistic regression equation was used to analyze the influencing factors of MDRO in coma-induced awakening patients.Results A total of 285 strains of pathogenic bacteria were detected in 211 sputum samples,among which 130 cases were MDRO(188 strains).The proportions of extended spectrum beta-lactamases(ESBLs)-producing Enterobacteriaceae bacteria,carbapenem-resistant Acinetobacter baumannii(CR-AB),and Methicillin-resistant staphylococcus aureus(MRSA)were 54.26%,32.98%,and 12.77%,respectively.There were statistically differences in age,mechanical ventilation duration,blood glucose level,combined use of antibiotics,National Institute of health stroke scale(NIHSS)score and nutritional risk between the two groups(P<0.05).Age,mechanical ventilation duration,blood glucose level,combined use of antibiotics,NIHSS score(OR=17.346),nutritional risk were risk factors for MDRO(P<0.05).Conclusion Age,mechanical ventilation time,blood glucose level,combined use of antibiotics,NIHSS score and nutritional risk are the risk factors for inducing MDRO.It is recommended to take clinical measures to prevent nosocomial infection.

关 键 词：广谱抗菌药物 昏迷促醒中心 多重耐药菌 影响因素 

分 类 号：R741[医药卫生—神经病学与精神病学]