长期卧床老年患者多药耐药菌感染影响因素

目的探究长期卧床老年患者多药耐药菌(MDROs)感染现状,并归纳其影响因素。方法选择2018年3月-2020年3月长期卧床MDROs感染患者108例作为研究对象,对感染患者检出病原菌,感染部位进行研究,收集患者的性别、年龄、卧床时间、住院时间、基础疾病、侵入性操作等临床资料,归纳长期卧床老年患者MDROs感染的影响因素。结果共收治长期卧床患者1 106例,MDROs感染108例,感染率为9.76%。MDROs感染患者共检出病原菌130株,以耐甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶大肠埃希菌、多药耐药鲍氏不动杆菌为主;感染部位分布位列前三位的为呼吸系统(75.00%)、泌尿系统(9.26%)与皮肤软组织(3.70%);年龄(OR=3.543)、入住老年科(OR=2.257)、卧床时间(OR=2.354)、合并慢性阻塞性肺疾病(OR=3.547)、合并糖尿病(OR=1.781)、抗菌药物应用种类(OR=5.842)、抗菌药物应用时间(OR=3.508)、使用呼吸机(OR=7.050)、中心静脉置管(OR=3.504)、留置尿管(OR=3.931)均为长期卧床老年患者MDROs感染的影响因素(P<0.05)。结论长期卧床老年患者MDROs感染风险较高,感染病原菌以耐甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶大肠埃希菌为主,感染部位以呼吸系统为主;高龄、入住老年科、卧床时间较长、合并慢性阻塞性肺疾病及糖尿病、不合理应用抗菌药物、有介入操作患者更易出现MDROs感染。

Influencing factors of multiple drug resistant organism infection in elderly patients with long-term bedridden

OBJECTIVE To explore the current status of multi-drug resistant organism(MDROs) infection in elderly patients with long-term bedridden and to summarize its influencing factors. METHODS From Mar. 2018 and Mar. 2020, 108 cases of MDROs infected patients with long-term bedridden were selected as the research subjects. The pathogenic bacteria and infection sites of the infected patients were analyzed. The clinical data such as gender, age, time in bed, hospital stay, underlying diseases, and invasive procedures were collected, and the influencing factors of MDROs infection in elderly patients with long-term bedridden were summarized. RESULTS A total of 1 106 cases of long-term bedridden patients were admitted, 108 cases were infected by MDROs, and the infection rate was 9.76%. A total of 130 strains of pathogenic bacteria were detected in patients infected with MDROs, and the dominated by methicillin-resistant Staphylococcus aureus(26.92%), extended-spectrum β-lactamase-producing Escherichia coli(24.62%) and multi-drug resistant Acinetobacter baumannii(23.85%). The top three infection sites were the respiratory system(75.00%), urinary system(9.26%) and skin soft tissues(3.70%). Age(OR=3.543), hospitalization in geriatric department(OR=2.257), time in bed(OR=2.354), complicated with chronic obstructive pulmonary disease(OR=3.547), complicated with diabetes(OR=1.781), types of antibacterial drugs used(OR=5.842), time of using antibacterial drugs(OR=3.508), use of ventilator(OR=7.050), central venous catheterization(OR=3.504) and indwelling urinary catheter(OR=3.931) were the influencing factors for MDROs infection in long-term bedridden elderly patients(P<0.05). CONCLUSION Long-term bedridden elderly patients have a higher risk of MDROs infection. The main pathogenic bacteria are methicillin-resistant S. aureus and extended-spectrum β-lactamase-producing E. coli, and the main infection sites was the respiratory system. Patients with advanced age, hospitalization in geriatric department, long time in bed, chronic obstructive pulmonary disease, diabetes, unreasonable use of antibacterial drugs and interventional operation are more susceptible to MDROs infection.