重症监护室不同置管患者多药耐药菌感染生存分析  

Survival analysis of intensive care unit patients with multidrug-resistant organisms infections treated with different catheters

作　　者：曹丽琴 石丽娟 刘洁 李佩玲 董宏亮 CAO Li-qin;SHI Li-juan;LIU Jie;LI Pei-ling;DONG Hong-liang(The Ninth Hospital of Xi'an,Xi'an,Shaanri 710054,China;不详)

机构地区：[1]西安市第九医院控感科,陕西西安710054 [2]西安市第九医院重症医学科,陕西西安710054 [3]宁夏医科大学公共卫生学院,宁夏银川750000

出　　处：《中华医院感染学杂志》2024年第14期2230-2234,共5页Chinese Journal of Nosocomiology

基　　金：国家卫生健康委医院管理研究所基金资助项目(GY2023024-B)。

摘　　要：目的 了解重症监护室(ICU)不同分组患者从入住ICU到多药耐药菌(MDROs)感染的时间及危险因素,量化置管患者的置管控制时间,为ICU医护人员预防与控制患者MDROs感染提供管理意见.方法 回顾性分析西安市第九医院2017年1月-2021年8月ICU不同置管患者基本情况,分析对比置管与非置管患者从入住ICU至感染MDROs所需的时间差异,并分析感染相关的危险因素.结果 纳入研究的样本为493例,其中163例(33.06%)感染MDROs,性别、是否使用呼吸机、导尿管及是否中心静脉置管在感染与非感染患者间差异有统计学意义(P<0.05);感染部位以下呼吸道感染为主137例(84.05%);感染菌种主要以耐碳青霉烯鲍氏不动杆菌(CRAB)最多82例(50.31%),送检标本以痰标本送检最多137例(84.05%);老年患者、女性、使用呼吸机、中心静脉置管为感染MDROs的危险因素(P<0.05).从入住ICU至感染MDROs的中位时间:老年患者8.00(6.28,9.72)d,女性8.00(6.73,9.27)d,使用呼吸机、导尿管、中心静脉导管置管患者感染时间分别为8.00(7.09,8.91)d、8.00(7.30,8.70)d、8.00(7.14,8.86)d.结论 ICU的患者在各种侵袭性导管的留置时间达到8 d后,将有50%的患者感染MDROs,且老年、女性、使用呼吸机、中心静脉置管是ICU患者感染MDROs的高危因素.OBJECTIVE To understand the time from ICU stay to multidrug-resistant organisms(MDROs)infec-tions,risk factors and catheter control time of quantified catheterization patients so as to provide guidance for pre-vention and control of MDROs infections in the patients.METHODS The baseline data of the ICU patients who were treated with different catheters in the Ninth Hospital of Xi'an from Jan 2017 to Aug 2021 were retrospective-ly analyzed,the difference in the time from ICU stay to MDROs infections was observed and compared between the catheterization patients and the non-catheterization patients.The risk factors for the related infections were an-alyzed.RESULTS Of 493 patients who were enrolled in the study,163(33.06%)had MDROs infections.There were significant differences in the gender,use of ventilator,urinary catheter and central venous catheter between the patients with infections and the patients without infections(P<0.05).The patients with lower respiratory tract infection(137 cases)were dominant among the patients with infections,accounting for 84.05%.Carbapenem-re-sistant Acinetobacter baumannii(CRAB)(82 cases)was the predominant species of pathogen causing the infec-tion,accounting for 50.31%.Sputum specimens(137 cases)were dominant among the submitted specimens,ac-counting for 84.05%.The elderly patient,female,use of ventilator and central venous catheterization were the risk factors for the MDROs infections(P<0.05).The median time from ICU stay to MDROs infections of the eld-erly patients was 8.00(6.28,9.72)days,the female 8.00(6.73,9.27)days,the time of infection of the patients trea-ted with ventilator was 8.00(7.09,8.91)days,the patients treated with urinary catheter 8.00(7.30,8.70)days,the patients treated with central venous catheter 8.00(7.14,8.86)days.CONCLUSION When the indwelling time of the invasive catheters reached 8 days,50%of the ICU patients may have MDROs infections.The elderly,female,use of ventilator and central venous catheter are the high risk factors for the MDROs infections in the

关 键 词：重症监护室 呼吸机 导尿管 中心静脉置管 多药耐药菌 生存分析 

分 类 号：R473[医药卫生—护理学]