上海市浦东新区社区感染和医院感染的多重耐药菌易感因素研究

【目的】探讨多重耐药菌的易感因素,比较社区感染和医院感染易感因素的异同,为科学防控多重耐药菌感染提供依据。【方法】采用病例对照研究,随机抽取社区感染和医院感染的多重耐药菌病例各120例作为研究组,根据可比原则1∶2选择各自的对照组(对照1组和对照2组)。调查内容包括宿主自身的原因、医源性因素、环境因素等。【结果】社区感染组与对照1组、医院感染组与对照2组在年龄、性别、居住类型上差异均无统计学意义(P>0.05)。调整相关因素后,感染前低蛋白血症、感染前白细胞数高或低、同病房出现多重耐药菌病例、患病时必服用抗菌药物是发生多重耐药菌医院感染的危险因素,OR值(95%可信区间)分别为4.009(2.232~7.203)、4.200(1.486~11.869)、4.725(2.918~7.651)、3.844(1.644~8.987)和2.786(1.359~5.714);感染前白细胞较高、患病时必服用抗菌药物是发生多重耐药菌社区感染的危险因素,OR值(95%可信区间)分别为4.290(1.646~11.178)、5.539(2.090~14.678)。【结论】良好地控制患者的蛋白质水平、白细胞水平,对多重耐药菌感染病例早期预警和处置以及合理使用抗菌药物是降低多重耐药菌感染发生率的有效措施。

Susceptibility factors of multi-drug-resistant bacteria in community and nosocomial infections in Pudong New Area of Shanghai

[Objective]To explore the susceptibility factors of multi-drug resistant bacteria,and compare the similarities and differences of susceptibility factors between community infection and nosocomial infection,providing basis for scientific prevention and control of multi-drug resistant bacterial infection.[Methods]A case-control study was conducted.For the study groups,we selected randomly 120 cases of multi-drug-resistant bacteria infection from communities and another 120 cases from hospitals,then according to the principle of comparability,the control groups were selected by the ratio of 1∶2(control group 1 and control group 2).The investigation included the causes of host itself,iatrogenic factors,environmental factors and so on.[Results]There was no significant difference in age,sex and type of residence between nosocomial infection and control groups,community infection and control groups(P>0.05).After adjusting the related factors,it was found that hypoproteinemia before infection,high or low leucocyte count before infection,multiple drug-resistant bacteria cases in the same ward,and taking antibiotics in case of illness were the causes of multiple drug resistance from nosocomial infection,the OR values and 95%confidence intervals were 4.009(2.232-7.203),4.200(1.486-11.869),4.725(2.918-7.651),3.844(1.644-8.987)and 2.786(1.359-5.714)respectively.High leucocyte count before infection and taking antibiotics for sickness were risk factors for community infection with multi-drug-resistant bacteria,the OR value and 95%confidence interval were 4.290(1.646-11.178)and 5.539(2.090-14.678)respectively.[Conclusion]Good control of protein level,leucocyte level,early warning and disposal of multi-drug-resistant bacteria cases,and rational use of antibiotics are effective measures to reduce the infection of multi-drug-resistant bacteria.