危重症康复病房多重耐药菌感染患者的病原学特征及危险因素分析  

A retrospective analysis of the etiological characteristics and infection risks of patients critically ill with multidrug-resistant bacteria in rehabilitation wards

作　　者：潘化平 王震 张小娇 弓瑾 赵剑锋 刘立芝 刘加美 冯慧月 吕芳 冯慧 Pan Huaping;Wang Zhen;Zhang Xiaojiao;Gong Jin;Zhao Jianfeng;Liu Lizhi;Liu Jiamei;Feng Huiyue;Lv Fang;Feng Hui(Rehabilitation Medicine Center,Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211103,China;Department of Critical Care Rehabilitation Medicine,Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211103,China;Department of Geriatric Rehabilitation,Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211103,China;Department of Hospital Infection Control,Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211103,China;Department of Clinical Pharmacy,Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211103,China;Department of Neurological Rehabilitation,Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211103,China)

机构地区：[1]南京医科大学附属江宁医院康复医学中心,南京211103 [2]南京医科大学附属江宁医院危重症康复科,南京211103 [3]南京医科大学附属江宁医院老年康复科,南京211103 [4]南京医科大学附属江宁医院医院感染管理科,南京211103 [5]南京医科大学附属江宁医院临床药学部,南京211103 [6]南京医科大学附属江宁医院神经康复科,南京211103

出　　处：《中华物理医学与康复杂志》2024年第3期205-209,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：江苏省重点研发计划(社会发展)项目(BE2021618);南京市医学重点科技发展项目(ZKX23062)。

摘　　要：目的探讨重症康复病房住院患者多重耐药菌微生物学及疾病分布特点,分析导致多重耐药菌感染的危险因素。方法回顾性分析2021年1月至12月由南京市江宁医院危重症康复科病房收治且符合纳入标准的679例患者的入院微生物学筛查结果,分为多耐组(多重耐药菌感染阳性,166例)和非多耐组(多重耐药菌感染阴性,513例),再进行Logistic回归分析相关危险因素。结果 679例患者的微生物学筛查中,检出369株多重耐药菌,其中革兰氏阴性菌329株(占89.2%),铜绿假单胞菌、肺炎克雷伯杆菌、大肠埃希菌是主要类型,主要分布于痰液(56.9%)、中段尿(28.2%)标本中;原发病为出血性和缺血性脑血管病的患者分别占多重耐药菌感染病例的40.96%和23.49%。Logistic回归分析结果显示,白蛋白水平(OR=0.923,95%CI=0.877~0.971,P<0.05)、依赖机械通气(OR=2.405,95%CI=1.197~4.831,P<0.05)、中心静脉插管(OR=4.198,95%CI=1.936~9.103,P<0.001)、留置尿管或膀胱造瘘管(OR=1.974,95%CI=1.345~2.897,P<0.05)是危重症康复科入院患者多重耐药菌感染的独立危险因素。结论危重症康复病房入院患者多重耐药菌感染以革兰氏阴性菌为主,而多重耐药菌感染的发生与低白蛋白水平、依赖机械通气、留置中心静脉置管、留置尿管或膀胱造瘘管因素有关。Objective To explore the microbiological and disease distribution characteristics of multidrug-resistant bacteria in patients hospitalized in a critical care rehabilitation ward,and to analyze the risk factors leading to multidrug-resistant bacterial infections.Methods Microbiology screening data describing 679 patients admitted to a critical care rehabilitation ward were retrospectively analyzed to divide the subjects into a multidrug-resistant group(positive for multidrug-resistant bacterial infections,n=166)and a non-multidrug-resistant group(negative for multidrug-resistant bacterial infections,n=513).The risk factors were then analyzed using logistic regression.Results Among 369 strains of multidrug-resistant bacteria observed,329 were gram-negative bacteria(89.2%),mainly Pseudomonas aeruginosa,Klebsiella pneumoniae and Escherichia coli.They were distributed in sputum(56.9%)and mid-epidemic urine(28.2%)specimens.Patients whose primary disease was hemorrhagic or ischemic cerebrovascular disease accounted for 40.96% and 23.49% of the multidrug-resistant bacterial infections,respectively.Logistic regression analysis showed that albumin level,dependence on mechanical ventilation,central venous cannulation,or an indwelling urinary catheter or cystostomy tube were significant independent predictors of such infections.Conclusion The multidrug-resistant bacterial infections of patients admitted to the critically ill rehabilitation unit are mainly caused by gram-negative bacteria.Their occurrence is closely related to low albumin levels and mechanical ventilation,as well as to bearing an indwelling central venous catheter,a urinary catheter or a cystostomy catheter.

关 键 词：危重症康复 监护病房 多重耐药菌 感染 回顾性分析 

分 类 号：R446.5[医药卫生—诊断学]