神经重症监护室患者医院获得性肺炎病原菌耐药性特点及护理干预效果  

Characteristics of drug resistance of pathogens with hospital-acquired pneumonia in patients in the intensive care unit of the neurology department and the role of nursing intervention in infection control

作　　者：陈德勋[1] 郝乔 揣春阳 CHEN Dexun;HAO Qiao;CHUAI Chunyang(Department of Neurology,The First Affiliated Hospital,Nanyang Medical College,Nanyang 473000,Henan,China)

机构地区：[1]南阳医学高等专科学校第一附属医院神经内科重症监护室,河南南阳473000

出　　处：《中国病原生物学杂志》2024年第12期1496-1500,共5页Journal of Pathogen Biology

摘　　要：目的本研究旨在分析神经重症监护室医院获得性肺炎(HAP)患者的病原菌分布及其耐药性特点,并探讨护理干预在感染控制中的作用。方法本研究纳入2022年1月至2024年6月在本院神经重症监护室住院并确诊为HAP的患者共118例。患者按照是否接受强化护理干预分为护理干预组(n=57)和常规护理组(n=61)。强化护理干预包括手卫生、气管插管管理、机械通气护理、早期拔管以及定期更换呼吸机回路等。收集患者的临床资料、病原菌培养结果和抗生素敏感性试验数据。使用卡方检验比较两组在多重耐药菌感染率、感染持续时间、ICU住院时间、抗生素使用天数及病死率等方面的差异。多因素logistic回归模型用于分析护理干预、抗生素使用天数、ICU住院时间等因素对多重耐药菌感染的独立影响。结果在118例医院获得性肺炎(HAP)患者中,主要分离出的病原菌为鲍曼不动杆菌(32.2%,38/118)、肺炎克雷伯菌(23.7%,28/118)、大肠埃希菌(19.5%,23/118)和铜绿假单胞菌(16.1%,19/118)。多重耐药菌(MDR)感染率为44.9%(53/118),主要集中在鲍曼不动杆菌(63.2%)和肺炎克雷伯菌(46.4%)。鲍曼不动杆菌对碳青霉烯类抗生素的耐药率为63.2%,对氨基糖苷类为55.3%,对氟喹诺酮类为48.6%;肺炎克雷伯菌对第三代头孢菌素的耐药率为50.0%,对碳青霉烯类为46.4%,对氟喹诺酮类为42.9%。护理干预组的MDR感染率显著低于常规护理组(29.8%vs.59.0%,P=0.012),感染持续时间(13dvs.19d,P=0.008)、ICU住院时间(22d vs.30d,P=0.015)和抗生素使用天数(9dvs.14d,P=0.011)均显著缩短,病死率也显著降低(15.8%vs.29.5%,P=0.041)。多因素logistic回归分析显示,护理干预是降低多重耐药菌感染的独立保护因素(OR=0.39,95%CI:0.20一0.76,P=0.007),抗生素使用天数(OR=1.14,95%CI:1.05-1.22,P=0.003)和ICU住院时间(OR=1.09,95%CI:1.04-1.13,P=0.002)为多重耐药菌感染的独立危险因素。结论在神经重症�Objective This study aimed to analyze the distribution and antibiotic resistance characteristics of pathogens in patients with hospital-acquired pneumonia(HAP)in the neurology intensive care unit(NICU),and to explore the role of nursing interventions in infection control.Methods A total of 118 patients diagnosed with HAP and admitted to the NICU of our hospital from January 2022 to June 2024 were included.Patients were divided into two groups based on whether they received enhanced nursing interventions:the intervention group(n=57)and the routine care group(n=61).Enhanced nursing interventions included hand hygiene,management of endotracheal intubation,mechanical ventilation care,early extubation,and regular replacement of ventilator circuits.Clinical data,pathogen cultures,and antibiotic susceptibility test results were collected.Chi-square tests were used to compare multidrugresistant(MDR)infection rates,infection duration,ICU stay length,antibiotic usage duration,and mortality between the two groups.A multivariate logistic regression model was used to analyze the independent effects of nursing interventions,antibiotic usage duration,and ICU stay length on MDR infections.ResultsAmong the 118 HAP patients,the main pathogens isolated were Acinetobacter baumannii(32.2%,38/118),Klebsiella pneumoniae(23.7%,28/118),Escherichia coli(19.5%,23/118),and Pseudomonas aeruginosa(16.1%,19/118).The total MDR infection rate was 44.9%(53/118),primarily involving A.baumanni(63.2%)and K.pneumoniae(46.4%).The resistance rate of A.baumannii to carbapenems was 63.2%,to aminoglycosides was 55.3%,and to fluoroquinolones was 48.6%;the resistance rate of K.pneumoniae to third-generation cephalosporins was 50.0%,to carbapenems was 46.4%,and to fluoroquinolones was 42.9%.The MDR infection rate in the intervention group was significantly lower than that in the routine care group(29.8%vs.59.0%,P=0.012).Additionally,infection duration(13 days vs.19 days,P=0.008),ICU stay length(22 days vs.30 days,P=0.015),and antibiotic usage duration(9 days

关 键 词：神经重症监护室 医院获得性肺炎 多重耐药菌 护理干预 感染控制 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]