心内科患者多药耐药铜绿假单胞菌医院感染危险因素的分析

目的 调查心内科住院患者多药耐药铜绿假单胞菌(MDRPA)的感染现状及医院感染的危险因素,为监测与控制心内科MDRpA感染提供依据.方法 收集心内科2007-2010年分离医院感染的MDRPA,采用Microscan Walk away 96SI全自动微生物鉴定仪鉴定并检测药物敏感性,将检测出的MDRP与同时期敏感铜绿假单胞菌作为对照,采用病例对照研究方法,单因素(t检验、x2检验)及多因素logistic回归进行分析.结果 连续收集到医院感染铜绿假单胞菌(PAE)80株,其中,MDRPA 25株,总分离率31.3％；主要标本来源是呼吸道标本,占77.5％;单因素分析发现,曾入住ICU、基础疾病、住院时间、纤维支气管镜灌洗、机械通气时间、分离出MDRPA前＜14 d使用碳青霉烯类抗菌药物与MDRP感染有关；多因素logistic回归分析确定了3项独立危险因素；曾入住ICU、机械通气、分离出MDRP前＜14 d用过碳青霉烯类抗菌药物.结论 曾入住ICU、机械通气以及碳青霉烯类抗菌药物的使用,是心内科住院患者MDRPA感染的危险因素；重视无菌技术操作,控制机械性通气的使用,改善住院病室条件是预防心内科MDRPA的重要措施.

Risk factors analysis of nosocomial infections caused by multidrug resistant Pseudomonas aeruginosa separated from vasculocardiology department

OBJECTIVE To provide the evidence for the monitoring and control of multiple drug-resistant Pseudomonas aeruginosa(MDRPA) infections through investigation of the current status of nosocomial infections caused by MDRPA and to analyze the risk factors.METHODS The drug susceptibility of MDRPA separated from vasculocardiology department of our hospital collected from 2007 to 2010 were tested by Microscan Walk away 96SI and compared with the susceptible strains as control.T-test,chi-square test and Logistic regression analysis were used for statistical analysis.RESULTS A total of 80 strains of non-repeated PAE were collected,of which the MDRPA accounted for 25 strains(31.3%).Samples mainly came from the respiratory system(77.5%).According to univariate analysis,the factors associated with the development of MDRP nosocomial infection were ever stay in ICU,mechanical ventilation,basic disease,length of stay,use of imipenem/meropenem up to 14 days before isolation of MDRP.Multivariate logistic regression analysis identified three independent factors:mechanical ventilation,ever stay in ICU,and previous imipenem/meropenem use.CONCLUSION Independent risk factors of MDRP infections of vasculocardiology department patients are ever stay in ICU,mechanical ventilation and used imipenem/meropenem.To control vasculocardiology department nosocomial pneumonia caused by MDRPA,we should enhance our survey on the patients,emphasize bacteria-free operation technology,and control the use of breathing-machine.