ICU脑卒中相关性肺炎患者感染多重耐药菌危险因素分析及病原学研究

目的 探讨入住ICU的脑卒中相关性肺炎(ICU-SAP)患者感染多重耐药菌(MDRO)的危险因素并分析其病原菌构成.方法 搜集2013年1月至2016年6月该院158例ICU-SAP患者的病例资料,分析MDRO感染率和其病原菌构成,筛选ICU-SAP发生MDRO感染的影响因素.结果 158例ICU-SAP患者中有106例发生MDRO感染,感染率为67.1％.感染患者呼吸道标本中共分离出146株MDRO,其中革兰阳性菌31株(21.2％),革兰阴性菌115株(78.8％).Logistic回归分析显示与ICU-SAP患者感染MDRO的因素包括SAP晚发型、ICU住院时间(≥72 h)、意识障碍、吞咽障碍和急性生理学及慢性健康(APACHEⅡ)评分(＞25分).结论 ICU-SAP患者感染MDRO比例高且以革兰阴性菌为主,晚发型SAP、ICU住院时间长、存在意识障碍或吞咽障碍及疾病严重程度偏重可增加其感染风险,应加以重视和干预,以降低发病率.

Analysis on risk factors and etiology of MDRO infection in patients with stroke associated pneumonia in ICU

Objective To investigate the risk factors of multi-drug resistant organism(MDRO) infection in the patients with stroke associated pneumonia in ICU (ICU-SAP) and to analyze the composition of pathogenic bacteria.Methods The medical record data of 158 inpatients with ICU-SAP in our hospital from January 2013 to June 2016 were collected and screened the influence factors for MDRO infection occurrence in ICU-SAP.Results One hundred fity-eight cases of ICU-SAP,106 cases developed MDRO infection,and the infection rate was 67.1％.A total of 146 strains of MDRO were isolated,of which 31 strains (21.2％) were Gram-positive bacteria and 115 strains(78.8 ％) were Gram-negative bacteria.The Logistic regression analysis showed that the risk factors for MDRO infection in ICU-SAP patients included late-onset SAP,ICU stay time(≥72 h),disturbance of consciousness,swallowing disorders and APACHE Ⅱ (＞25 points).Conclusion The proportion of ICU-SAP patients infected with MDRO is high,and Gram-negative bacilli are the primary pathogen.These factors such as late-onset SAP,long ICU stay time,disturbance of consciousness,swallowing disorders and increased disease severity increase the MDRO infection risk,which should be paid attention to in order to reduce the morbidity of MDRO infection.