多重耐药菌感染术后肺炎相关危险因素分析及控制方法学探究

  目的  通过监测胸外科术后肺炎医院感染的发生情况，分析多重耐药菌感染所致术后肺炎的相关危险因素，从而制定相应防控和干预措施，以降低术后肺炎感染发生率及多重耐药菌感染所致的术后肺炎发生率，有效加速患者术后康复。  方法  通过对2016—2018年入住胸外科的所用手术患者610例进行医院感染目标性监测，分析多重耐药菌感染所致术后肺炎发生情况及感染相关危险因素。采用SPSS 20.0软件对数据进行统计分析。  结果  检出铜绿假单胞菌最多:共22株，占比50.00%(22/44)。检出的多重耐药菌主要为:耐碳青霉烯鲍曼不动杆菌共8株，占比53.33%(8/15)。多重耐药菌感染导致的术后肺炎感染率呈现下降趋势，从2016年的3.38%降至2018年的1.37%，对其危险因素进行单因素分析发现:抗生素使用≥14 d、留置导尿管、进行机械通气、入住重症监护病房、ASA评分≥Ⅱ、使用抗菌药物种类≥3种等因素是主要危险因素(均P＜0.05)，经logistic多因素分析结果发现，仅抗生素使用时间是多重耐药菌感染所致术后肺炎感染的相关独立危险因素。  结论  通过有效的医院感染监测及危险因素分析，可发现多重耐药菌感染所致术后肺炎的主要感染危险因素，从而降低多重耐药菌感染所致术后肺炎的发生率。 

Analysis of risk factors related to pneumonia after multidrug-resistant bacterial infection and exploration of control methodology

Objective This study aimed to monitor the incidence of nosocomial pneumonia caused by multidrug-resistant bacteria after thoracic surgery;analyse the risk factors of postoperative pneumonia caused by multidrug-resistant bacteria;develop corresponding prevention,control and intervention measures and reduce the incidence of postoperative pneumonia and multidrug-resistant bacterial infection,thereby accelerating the postoperative recovery of patients.Methods A total of 610 patients were admitted to the Department of Thoracic Surgery from 2016 to 2018 and monitored for nosocomial infection,and the incidence of postoperative pneumonia caused by multidrug-resistant bacterial infection and the risk factors associated with infection were analysed.SPSS 20.0 software was used for statistical analysis of data.Results A total of 22 strains of Pseudomonas aeruginosa were detected,accounting for 50.00%(22/44),and 8 strains of carbapenem-resistant Acinetobacter baumannii were detected,accounting for 53.33%(8/15).The rate of postoperative pneumonia caused by multidrug-resistant bacterial infection decreased from 3.38%in 2016 to 1.37%in 2018,and single-factor analysis showed the following risk factors:antibiotic use for 14 days,urethral catheter or mechanical ventilation.The length of stay in intensive care unit,ASA score acuityⅡand use of antimicrobial agents are the main risk factors(all P<0.05).Logistic multifactor analysis showed that only antibiotic use was the related independent risk factor of postoperative pneumonia caused by multidrug-resistant bacterial infection.Conclusion The main risk factors of postoperative pneumonia caused by multidrug-resistant bacterial infection can be found through effective nosocomial infection monitoring and risk factor analysis,thereby reducing the incidence of postoperative pneumonia caused by multidrug-resistant bacterial infection.