重症监护病房内耐甲氧西林金黄色葡萄球菌感染的现状分析
发布时间：2018-09-14 07:22
【摘要】：目的通过对耐甲氧西林金黄色葡萄球菌(MRSA)感染病例的调查,了解MRSA的感染现状,探讨重症监护病房内MRSA感染的危险因素、临床特征及预后,为采取措施预防与控制MRSA感染提供依据。方法对我院2012年1月-2013年12月期间,对重症监护病房(intensive care unit,ICU)内787例患者进行了MRSA感染监测。以2012-2013年我院ICU内MRSA感染患者作为病例组,非MRSA感染患者作为对照组,采用流行病学研究方法,统计分析的变量主要依据综述和临床经验来确定;使用SPSS 17.0软件对数据进行统计分析,应用非条件Logistic回归分析对资料进行单因素分析与多因素分析,寻找MRSA感染的独立危险因素。对实验室指标(血常规、肝肾功能、凝血功能、血气分析、心肌坏死标记物等)与MRSA感染的关系进行两独立样本t检验;对MRSA感染的死亡率、肺功能障碍发生率、肝功能障碍发生率等进行卡方检验。结果1.86例金黄色葡萄球菌(SA)感染患者中,54例为MRSA感染病例,MRSA感染发生率为62.79%;2012年感染率为68.18%,2013年感染率为57.14%(χ2=1.121,P=0.290);787例住院患者中,MRSA发病率为6.86%,其中,2012年MRSA发病率为8.13%,2013年发病率为5.74%(χ2=1.749,P=0.186)。2.纳入单因素分析的变量共62个,经过统计分析,筛选出12个变量进入多因素Logistic回归模型;年龄(OR=1.047,95%CI:1.009~1.086)、ICU住院天数(OR=1.050,95%CI:1.012~1.089)、使用激素/免疫抑制剂(OR=2.853,95%CI:1.177~6.911)、机械通气(OR=4.918,95%CI:1.175~20.583)、抗菌药物使用超过7天(OR=3.257,95%CI:1.055~10.058)是MRSA感染的独立危险因素;MRSA感染组进行机械通气的暴露率为92.59%,对照组进行机械通气的暴露率为59.21%(χ2=23.673,P0.001);MRSA感染组使用激素的暴露率为62.96%,而对照组使用激素的暴露率为25.24%(χ2=35.64,P0.001);MRSA感染组抗菌药物使用≥7d的暴露率为74.07%,而对照组抗菌药物使用≥7d的暴露率为20.87%(χ2=76.90,P0.001);MRSA感染组使用广谱抗菌药物的暴露率为81.48%,而对照组使用广谱抗菌药物的暴露率为66.44%(χ2=5.185,P=0.023)。3.共收集天津医科大学第二医院2年时间内非重复MRSA菌株54株,经分析统计,所有产生MRSA的标本中,痰液占30株(55.56%),肺泡灌洗液占14株(25.93%),咽拭子占8株(14.81%),血液占2株(3.70%)。4.对两组的临床生化指标进行独立样本t检验后得出,MRSA感染组的平均血小板计数为(220.74±88.81)*109/L,对照组的平均血小板计数为(183.92±102.04)*109/L,两组的平均血小板计数有显著性差异(t=2.492,P=0.013);MRSA感染组的平均实际HCO3-为(24.43±8.07)mmol/L,非MRSA感染组的平均HCO3-为(21.85±7.56)mmol/L,两组的平均实际HCO3-有显著性差异(t=2.282,P=0.023)。5.MRSA感染组的平均ICU住院时间为(24.94±33.19)d,而非MRSA感染组的的平均ICU住院时间为(7.69±9.19)d,且两组的差异有统计学意义(t=7.685,P0.001);MRSA感染组ALB28g/L有30例,的发生率为55.56%,对照组ALB28g/L的发生率为40.79%(χ2=4.506,P=0.034);MRSA组RR20次/分的发生率为62.96%,对照组RR20次/分的发生率为48.84%(χ2=4.013,P=0.045)。结论高龄、长期住院、进行机械通气、使用激素/免疫抑制剂、长期使用抗菌药物是ICU内MRSA感染的独立危险因素;MRSA感染导致血小板计数及实际HCO3-增高,并且延长了患者的住院时间;MRSA感染组肝、肺功能障碍的发生率更高。应根据患者病情特点,积极采取预防控制措施,防止耐药菌的产生和传播。
[Abstract]:Objective To investigate the infection status of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care unit (ICU), to explore the risk factors, clinical features and prognosis of MRSA infection, and to provide evidence for the prevention and control of MRSA infection. 787 patients in intensive care unit (ICU) were monitored for MRSA infection. The patients with MRSA infection in ICU from 2012 to 2013 were selected as the case group and the patients without MRSA infection as the control group. Epidemiological methods were used. The variables of statistical analysis were mainly determined by summary and clinical experience. SPSS 17.0 software was used to integrate the data. Univariate analysis and multivariate analysis were used to identify independent risk factors for MRSA infection. Two independent t-test samples were used to examine the relationship between laboratory parameters (blood routine, liver and kidney function, coagulation function, blood gas analysis, myocardial necrosis markers, etc.) and MRSA infection. Results Among 1.86 cases of Staphylococcus aureus (SA) infection, 54 cases were MRSA infection, and the incidence of MRSA infection was 62.79%. The infection rate in 2012 was 68.18%. The infection rate in 2013 was 57.14%(2=1.121, P=0.290). Among them, the incidence of MRSA was 8.13% in 2012 and 5.74% in 2013 (2 = 1.749, P = 0.186). 62 variables were included in the univariate analysis. After statistical analysis, 12 variables were selected into the multivariate logistic regression model; age (OR = 1.047, 95% CI: 1.009-1.086), length of stay in ICU (OR = 1.050, 95% CI: 1.012-1.089), hormone / immunosuppressive therapy was used. Preparations (OR = 2.853,95% CI: 1.177-6.911), mechanical ventilation (OR = 4.918,95% CI: 1.175-20.583), antimicrobial use more than 7 days (OR = 3.257,95% CI: 1.055-10.058) were independent risk factors for MRSA infection; exposure rate of mechanical ventilation in MRSA infection group was 92.59%, and that of control group was 59.21% (2 = 23.673, P 0.001). The exposure rate of using hormones in the infected group was 62.96%, while that in the control group was 25.24% (2 = 35.64, P 0.001); that in the MRSA infected group was 74.07% after using antibiotics for more than 7 days, and that in the control group was 20.87% (2 = 76.90, P 0.001); that in the MRSA infected group was 81.48% after using broad-spectrum antibiotics, while that in the control group was 74.07%. The exposure rate of the control group to broad-spectrum antibiotics was 66.44% (_2 = 5.185, P = 0.023). A total of 54 strains of non-repetitive MRSA were collected from the Second Hospital of Tianjin Medical University in two years. According to the analysis and statistics, 30 strains (55.56%) were sputum, 14 strains (25.93%) were alveolar lavage fluid, 8 strains (14.81%) were throat swabs, and 2 strains (3.70%) were blood. 4. The average platelet count in MRSA infection group was (220.74 [88.81] * 109/L, and that in control group was (183.92 [102.04] * 109/L. There was a significant difference in the average platelet count between the two groups (t = 2.492, P = 0.013). 7) mmol / L, the average HCO3 - in the non-MRSA infection group was (21.85 (7.56) mmol / L, and the average actual HCO3 - in the two groups was significantly different (t = 2.282, P = 0.023). 5. The average ICU hospitalization time in the MRSA infection group was (24.94 (33.19) days, while the average ICU hospitalization time in the non-MRSA infection group was (7.69 (9.19) days, and the difference between the two groups was statistically significant (t = 7.685, P 0.001). The incidence of ALB28g/L in MRSA infection group was 55.56%. The incidence of ALB28g/L in control group was 40.79%(2=4.506,P=0.034). The incidence of RR20 times/min in MRSA group was 62.96%. The incidence of RR20 times/min in control group was 48.84%(2=4.013,P=0.045). Antimicrobial agents are independent risk factors for MRSA infection in ICU. MRSA infection leads to increased platelet count and actual HCO3 - and prolongs hospitalization time. The incidence of liver and lung dysfunction is higher in MRSA infection group. Preventive and control measures should be taken to prevent the emergence and spread of drug-resistant bacteria according to the characteristics of patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5
本文编号：2241979
[Abstract]:Objective To investigate the infection status of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care unit (ICU), to explore the risk factors, clinical features and prognosis of MRSA infection, and to provide evidence for the prevention and control of MRSA infection. 787 patients in intensive care unit (ICU) were monitored for MRSA infection. The patients with MRSA infection in ICU from 2012 to 2013 were selected as the case group and the patients without MRSA infection as the control group. Epidemiological methods were used. The variables of statistical analysis were mainly determined by summary and clinical experience. SPSS 17.0 software was used to integrate the data. Univariate analysis and multivariate analysis were used to identify independent risk factors for MRSA infection. Two independent t-test samples were used to examine the relationship between laboratory parameters (blood routine, liver and kidney function, coagulation function, blood gas analysis, myocardial necrosis markers, etc.) and MRSA infection. Results Among 1.86 cases of Staphylococcus aureus (SA) infection, 54 cases were MRSA infection, and the incidence of MRSA infection was 62.79%. The infection rate in 2012 was 68.18%. The infection rate in 2013 was 57.14%(2=1.121, P=0.290). Among them, the incidence of MRSA was 8.13% in 2012 and 5.74% in 2013 (2 = 1.749, P = 0.186). 62 variables were included in the univariate analysis. After statistical analysis, 12 variables were selected into the multivariate logistic regression model; age (OR = 1.047, 95% CI: 1.009-1.086), length of stay in ICU (OR = 1.050, 95% CI: 1.012-1.089), hormone / immunosuppressive therapy was used. Preparations (OR = 2.853,95% CI: 1.177-6.911), mechanical ventilation (OR = 4.918,95% CI: 1.175-20.583), antimicrobial use more than 7 days (OR = 3.257,95% CI: 1.055-10.058) were independent risk factors for MRSA infection; exposure rate of mechanical ventilation in MRSA infection group was 92.59%, and that of control group was 59.21% (2 = 23.673, P 0.001). The exposure rate of using hormones in the infected group was 62.96%, while that in the control group was 25.24% (2 = 35.64, P 0.001); that in the MRSA infected group was 74.07% after using antibiotics for more than 7 days, and that in the control group was 20.87% (2 = 76.90, P 0.001); that in the MRSA infected group was 81.48% after using broad-spectrum antibiotics, while that in the control group was 74.07%. The exposure rate of the control group to broad-spectrum antibiotics was 66.44% (_2 = 5.185, P = 0.023). A total of 54 strains of non-repetitive MRSA were collected from the Second Hospital of Tianjin Medical University in two years. According to the analysis and statistics, 30 strains (55.56%) were sputum, 14 strains (25.93%) were alveolar lavage fluid, 8 strains (14.81%) were throat swabs, and 2 strains (3.70%) were blood. 4. The average platelet count in MRSA infection group was (220.74 [88.81] * 109/L, and that in control group was (183.92 [102.04] * 109/L. There was a significant difference in the average platelet count between the two groups (t = 2.492, P = 0.013). 7) mmol / L, the average HCO3 - in the non-MRSA infection group was (21.85 (7.56) mmol / L, and the average actual HCO3 - in the two groups was significantly different (t = 2.282, P = 0.023). 5. The average ICU hospitalization time in the MRSA infection group was (24.94 (33.19) days, while the average ICU hospitalization time in the non-MRSA infection group was (7.69 (9.19) days, and the difference between the two groups was statistically significant (t = 7.685, P 0.001). The incidence of ALB28g/L in MRSA infection group was 55.56%. The incidence of ALB28g/L in control group was 40.79%(2=4.506,P=0.034). The incidence of RR20 times/min in MRSA group was 62.96%. The incidence of RR20 times/min in control group was 48.84%(2=4.013,P=0.045). Antimicrobial agents are independent risk factors for MRSA infection in ICU. MRSA infection leads to increased platelet count and actual HCO3 - and prolongs hospitalization time. The incidence of liver and lung dysfunction is higher in MRSA infection group. Preventive and control measures should be taken to prevent the emergence and spread of drug-resistant bacteria according to the characteristics of patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5
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