重症监护病房嗜麦芽窄食单胞菌医院感染的危险因素

目的了解重症监护病房(ICU)嗜麦芽窄食单胞菌医院感染的疾病负担和危险因素。方法收集中南大学湘雅医院综合ICU2017年1月1日—12月31日嗜麦芽窄食单胞菌医院感染的患者作为病例组,每1例病例组患者配对2例性别相同、年龄相差≤3岁的无感染者作为对照组。收集各组的人口学信息、疾病严重程度、住院时长、住院费用、基础疾病、侵袭性操作,抗菌药物使用情况等信息,采用logistic回归分析方法进行危险因素分析。结果 ICU嗜麦芽窄食单胞菌医院感染的发病率为1.47%(29/1 973),例次发病率为1.57%(31/1 973)。入院至感染时长为(17.86±16.51)d,入ICU至感染时长为(7.34±9.12)d。感染部位以肺部为主(占74.19%)。病例组的住院时长、ICU住院时长、住院费用、抗菌药物费用均高于对照组,而治愈比例低于对照组。该菌对复方磺胺甲口恶唑和米诺环素敏感率在90%以上,而对头孢哌酮/舒巴坦不敏感的比率超过75%。病例组共有27例(93.10%)临床送检标本分离出其他细菌82株,其中多重耐药菌59株(71.95%);10例次(34.48%)患者分离出真菌13株。单因素分析显示病例组患者年龄较大,男性比例高,入住ICU时间长,APACHEⅡ评分、空腹血糖高,血红蛋白低,机械通气、中心静脉置管、使用纤支镜、血液净化治疗、输血、化学治疗、使用头孢菌素+酶抑制剂、青霉素类+酶抑制剂、碳青霉烯类、喹诺酮类、糖肽类的比例高。多因素logistic分析显示使用头孢菌素+酶抑制剂、碳青霉烯类和糖肽类是嗜麦芽窄食单胞菌医院感染的独立危险因素。结论嗜麦芽窄食单胞菌医院感染多发生于年龄大、病情重、住院时间长和使用强力广谱抗菌药物的患者,需加强监测和防控。ICU患者嗜麦芽窄食单胞菌医院感染的疾病负担较重,同时该菌耐药性也在不断增强。

Risk factors for healthcare-associated infection of Stenotrophomonas maltophilia in intensive care unit

Objective To assess the disease burden and risk factors of healthcare-associated infection(HAI) caused by Stenotrophomonas maltophilia(S. maltophilia) in intensive care unit (ICU). Methods Patients with HAI caused by S. maltophilia in general ICU of Xiangya Hospital of Central South University from January 1 to December 31, 2017 were collected as case group, each case was matched with 2 non-infected patients of the same gender and age difference ≤ 3 years old as control group. Data about demographic information, disease severity, length of hospital stay, hospitalization expense, underlying diseases, invasive operations, and antimicrobial use were collected, risk factors were analyzed by logistic regression analysis. Results Incidence and case incidence of S. maltophilia HAI in ICU were 1.47% (29/1 973) and 1.57% (31/1 973) respectively. Duration from admission to infection was (17.86±16.51)days, duration from admission in ICU to infection was(7.34±9.12)days. The main infection site was lung (74.19%). Length of hospital stay and ICU stay, hospitalization expenses and antimicrobial expenses of case group were all higher than control group, while cure rate was lower than control group. Susceptibility rate of S. maltophilia to compound sulfamethoxazole and minocycline was more than 90%, while non-susceptibility rate to cefoperazone/sulbactam was more than 75%. In case group, 82 strains of other bacteria were isolated from 27 (93.10%) clinical specimens, including 59 strains (71.95%)of multidrug-resistant organisms; 13 strains of fungi were isolated from 10 cases of infection (34.48%). Univariate analysis showed that patients in case group were with older age, high proportion of males, long length of ICU stay, higher APACHE Ⅱ score and fasting blood sugar, lower hemoglobin, high proportion of mechanical ventilation, central venous catheterization, fiberoptic bronchoscopy, blood purification treatment, blood transfusion, chemotherapy, cephalosporins and enzyme inhibitors, penicillins+enzyme inhibitors, carbapenems, quinolones and glycopeptides treatment. Multivariate logistic analysis showed that the use of cephalosporins+enzyme inhibitors, carbapenems and glycopeptides were independent risk factors for S. maltophilia HAI. Conclusion S. maltophilia HAI mostly occurrs in patients with old age, serious illness, long length of hospital stay and use of broad-spectrum antimicrobial agents, it is necessary to strengthen surveillance, prevention and control. The burden of S. maltophilia HAI in ICU patients is heavy, antimicrobial resistance is increasing.