重症监护病房脓毒血症患者病原学分布及死亡高危因素分析

目的　探讨重症监护病房（ICU）脓毒血症患者的临床特征、病原菌的分布及死亡高危因素。方法　选取2016年1 月～ 2018 年12 月在宁夏医科大学总医院心脑血管病医院ICU 科确诊的脓毒血症患者198 例，分析其病原菌分布及耐药情况，根据患者预后情况分为生存组（137 例）和死亡组（61 例），对患者29 项死亡高危因素进行单因素、多因素Logistic 回归分析。结果　共检出210 株病原菌，其中革兰阴性菌122 株（58.1%）、革兰阳性菌78 株（37.1%）、真菌8 株（3.8%）、厌氧菌2 株（1.0%）；排前六位的病原菌依次为大肠埃希菌（20.4%）、肺炎克雷伯菌（16.2%）、凝固酶阴性葡萄球菌（16.2%）、鲍曼不动杆菌（8.6%）、金黄色葡萄球菌（7.2%）及肠球菌属（7.6%）；210 株致病菌中共检出99 株多重耐药菌株，耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为31.2% 和68.0%，产超广谱β- 内酰胺酶（ESBLs）的大肠埃希菌和肺炎克雷伯菌检出率分别为49.0%和41.4%，耐碳青霉烯类药物的菌株占21.3%；对死亡组和生存组资料进行单因素及多因素Logistic 回归分析得出:APACHE II 评分≥ 18 分、糖尿病、基础疾病≥ 2 种、多种细菌混合感染、多重耐药菌感染、脓毒性休克、多脏器功能衰竭、侵入性治疗、NT- proBNP 和PCT 是影响患者预后的独立危险因素（P ＜ 0.05）。结论　ICU 脓毒血症患者分离的病原菌种类多，耐药性高，导致患者死亡的因素较多，临床应加强这些危险因素的监测管理，早期制定有效的抗感染治疗方案。

Etiology Distribution and Risk Factors of Death in Patients withSevere Sepsis in Intensive Care Unit

Objective　To explore the clinical characteristics, the distribution of pathogenic bacteria and the high risk factors fordeath of patients with sepsis in intensive care unit (ICU). Methods　From January 2016 to December 2018, 198 patients withsepsis in ICU were selected to analyze the distribution of pathogens and drug resistance. According to the prognosis of patients,they were divided into survival group (137 cases) and death group (61 cases),and the univariate,multivariate Logistic regressionanalysis was carried out for the 29 high-risk factors for death. Results　A total of 210 strains of pathogenic bacteria weredetected including 122 strains of Gram-negative bacteria (58.1%), 78 strains of Gram-positive bacteria (37.1%), 8 strains of fungi(3.8%), and 2 strains of anaerobic bacteria (1.0%).The top six pathogens were Escherichia coli (20.4%), Klebsiella pneumoniae(16.2%), Coagulase negative staphylococcus (16.2%), Acinetobacter baumannii (8.6%), Staphylococcus aureus (7.2%) andEnterococcus (7.6%).A total of 99 multidrug-resistant strains were detected in the 210 pathogenic bacteria. Among them, thedetection rates of MRSA and MRCNS were 31.2% and 68.0%, respectively, the proportion of producing extended spectrum β-lactamases in Escherichia coli and Klebsiella pneumoniae was 49.0% and 41.4%, respectively, and the detection rates ofcarbapenem resistant strains were 21.3% .The data of death group and survival group were analyzed by the univariate,multivariateLogistic regression analysis and it was concluded that the APACHE II score no less than 18 points, diabetes, more than 2 kinds ofbasic diseases, mixed infection of various bacteria, multiple Drug-resistant bacteria infection, septic shock, multiple organ failure,invasive treatment, NT- proBNP and PCT were the independent risk factors for the death(P ＜ 0.05). Conclusion　There weremany kinds of pathogenic bacteria isolated from patients with sepsis in ICU, with high drug resistance and many factors leadingto death.We should strengthen the monitoring and management of these risk factors in clinical practice, and make effective antiinfectiontreatment plan in the early stage.