外科重症监护病房下呼吸道感染病原菌监测及多重耐药菌感染的危险因素分析

目的探讨外科重症监护病房(SICU)下呼吸道感染病原菌的分布特点以及多重耐药菌(MDRB)感染的危险因素。方法回顾性分析210例SICU收住的下呼吸道感染患者资料,分析MDRB感染的危险因素。结果共分离出MDRB 57株,前三位分别为鲍曼不动杆菌(42.1%)、金黄色葡萄球菌(19.3%)和铜绿假单胞菌(17.5%)。多因素Logistic回归分析显示,年龄(>70岁)(OR:1.871,95%CI:1.012-3.460)、ICU住院时间(>2周)(OR:2.192,95%CI:1.161-4.138)、ICU住院次数(>1次)(OR:4.267,95%CI:1.689-10.780)、应用碳青霉烯类抗生素(OR:4.373,95%CI:2.277-8.397)和慢性阻塞性肺病病史(OR:2.577,95%CI:1.324-5.067)为MDRB下呼吸道感染的独立危险因素。结论减少碳青霉烯类抗生素的使用、严格遵守ICU收治指征并尽量缩短ICU住院时间有利于预防下呼吸道MDRB感染。

Monitoring of pathogens in lower respiratory tract infection and analysis of risk factors related to multi-drug resistant bacteria infection in surgical intensive care unit

Objective To investigate the distribution characteristics of the pathogens in lower respiratory tract infection and the risk factors related to the multi-drug resistant bacteria infection in surgical intensive care unit(SICU).Methods The data of 210 patients with lower respiratory tract infection in SICU were retrospectively analyzed.The risk factors related to multi-drug resistance were also studied using multivariate logistic regression analysis.Results Of 210 patients,57 multi-drug resistant bacteria were detected,and the first three were Acinetobacter baumannii(42.1%),Staphylococcus aureus(19.3%) and Pseudomonas aeruginosa(17.5%).Multivariate logistic regression analysis showed that the age(>70 years old)(OR:1.871,95%CI:1.012-3.460),the hospital stays(>2 weeks)(OR:2.192,95%CI:1.161-4.138),the administration times(>1 time)(OR:4.267,95%CI:1.689-10.780),using of carbapenem antibiotics(OR:4.373,95%CI:2.277-8.397),and chronic obstructive pulmonary disease(OR:2.577,95%CI:1.324-5.067) were the independent risk factors for multi-drug resistant bacteria infection.Conclusion Reduced use of carbapenem antibiotics,strict indications for admission and shortened hospital stay are helpful in preventing multi-drug resistant bacteria infection in lower respiratory tract.