术后MRSA肺炎的危险因素分析

目的分析术后耐甲氧西林金黄色葡萄球菌（MRSA）肺炎相关危险因素,以制定有效的防护措施。方法回顾性收集2007年10月—2008年12月我院急症和择期手术后确诊为肺炎的406例病人的资料,用SPSS软件分析术后MRSA肺炎相关危险因素。结果确诊MRSA肺炎33例,检出率为8.12%,死亡8例,病死率24.2%。单因素相关分析筛选出术后MRSA肺炎发病的8项可能危险因素：年龄≥60岁、住院≥20 d、广谱抗生素使用〉10 d、颅脑手术、气管插管或切开（未行机械通气）、机械通气、深静脉置管、抑酸剂的应用。多因素Logistic回归分析提示,住院≥20 d、广谱抗生素使用〉10 d、颅脑手术、气管插管或切开是术后MRSA肺炎发病的独立危险因素。结论住院≥20 d、广谱抗生素使用〉10 d、颅脑手术、气管插管或切开是术后MRSA肺炎发病的独立危险因素,需要综合预防才能降低其发病率。

RISK FACTORS OF POSTOPERATIVE MRSA PNEUMONIA

Objective To analyze risk factors that cause postoperative methicillin-resistant staphylococcus aureus（MRSA） pneumonia,and set up protective strategies. Methods Clinical data of 406 patients with postoperative pneumonia afteracute or selected surgery,between Oct.2007 and Dec.2008,were reviewed.Postoperative-MRSA-pneumonia-related risk factors were analyzed with SPSS software. Results Thirty-three patients developed postoperative MRSA pneumonia,the detection rate was 8.12%.Eight patients（24.2%） died.The eight possible risk factors of postoperative MRSA pneumonia,identified with univariate Pearson Chi-Square test,were age ≥60 years,hospital stay ≥20 d,broad-spectrum antibiotics usage（10 d）,brain surgery,endotracheal intubation or incision（without mechanical ventilation）,mechanical ventilation,intravenous catheter,and the application of acid suppression agents.Multivariable logistic regression analysis revealed that hospitalization ≥ 20 d,broad-spectrum antibiotics 10 d,brain surgery,endotracheal intubation or incision were independent risk factors of postoperative MRSA pneumonia. Conclusion Hospital stay ≥20 d,broad-spectrum antibiotics application 10 d,brain surgery,and endotracheal intubation or incision are independent risk factors of postoperative MRSA pneumonia.Only comprehensive prevention is carried out,can we reduce the morbidity of MRSA.