某三级综合医院RICU患者鲍曼不动杆菌感染现状及对策研究

发布时间：2018-06-25 02:00

本文选题：鲍曼不动杆菌 + 耐药　；参考：《山东大学》2016年硕士论文

【摘要】：研究背景：鲍曼不动杆菌属不发酵糖革兰阴性杆菌,在大自然、人体皮肤及医院环境中广泛分布,属于条件致病菌,能长期存活在自然环境和人体表面。鲍曼不动杆菌具有极强的克隆传播能力及获得耐药性,广泛耐药、全耐药与多重耐药鲍曼不动杆菌已经成为世界性的流行趋势。引起医院获得性肺炎、腹腔的感染、泌尿系统的感染、血流感染、皮肤软组织的感染、中枢神经系统感染的鲍曼不动杆菌,已成为院内感染的重要病原菌之一。中国CHINET 2010年细菌耐药性监测网的数据显示,我国10个省市范围内的14家综合教学医院临床分离出的革兰阴性菌中,鲍曼不动杆菌占16.11%,仅排在大肠埃希菌和肺炎克雷伯菌之后。鲍曼不动杆菌感染的主要危险因素有：住院时间长、抗菌药物暴露、给予机械通气、有创性操作、入住监护室及基础性严重疾病等。一旦感染,患者住院时间就会延长,同时增加住院费用,甚至导致患者死亡率升高。因此,鲍曼不动杆菌的感染及耐药情况引起了医务工作人员的广泛关注。研究目的：本文通过对某三甲综合医院RICU患者的微生物培养结果及临床诊疗资料进行研究分析,评估该院鲍曼不动杆菌的感染情况及耐药现状,同时比较性别、年龄、基础疾病、APACHE Ⅱ评分、侵入性操作等因素对鲍曼不动杆菌感染率的影响,并通过多因素Logistic回归分析找到鲍曼不动杆菌感染的危险因素及相应的OR值,以期探讨鲍曼不动杆菌感染的预防及其隔离防护措施。资料与方法：本研究回顾性分析了2010年-2011年入住某三甲综合医院呼吸内科监护病房(RICU)的264例患者,通过该院的病例查询系统,收集上述患者的临床病例资料,包括各类标本实验室微生物检查结果、人口学资料、急性生理学与慢性健康状况评分系统Ⅱ (APACHE Ⅱ)评分、合并的基础疾病、侵入性操作、药物使用情况、细菌耐药性、预后情况等。通过整理资料并进行统计分析,评估该院RICU患者鲍曼不动杆菌的感染率及耐药现状,分析RICU鲍曼不动杆菌感染患者混合感染的情况,比较性别、年龄、侵入性操作、基础疾病、APACHE Ⅱ评分等因素对鲍曼不动杆菌感染率的影响,探讨RICU患者鲍曼不动杆菌感染的风险因素及相应的OR值,进一步探讨鲍曼不动杆菌感染的预防及其隔离防护措施。统计学方法：对计量资料的比较采用t检验(正态分布)或秩和检验(非正态分布),对计数资料的比较采用卡方检验。而对分类资料的多因素分析采用多因素logistic回归分析,求出相应的OR值及其95%的置信区间,采用Wald检验对回归系数进行假设检验,P0.05为差异有统计学意义。主要结果：共收集264例RICU住院患者,其中男性160人,女性104人,年龄33-92岁,平均67.3岁。总感染率为27.65%,其中男性感染率为28.75%,女性为25.96%。感染率与APACHE Ⅱ评分相关性分析：RICU患者鲍曼不动杆菌感染率与APACHE Ⅱ评分成正相关,相关系数r.=0.9632。通过Logistic回归分析,得出RICU患者鲍曼不动杆菌感染的独立危险因素为创伤性操作(OR=4.257)、真菌感染(OR=3.782)、APACHE Ⅱ评分(OR=2.532)、合并基础疾病(OR=2.104)、高龄(OR=1.812)。结论与建议：1.该院RICU患者鲍曼不动杆菌的感染率较高,耐药形势严峻。2.侵入性操作、真菌感染、APACHE Ⅱ评分、合并基础疾病、高龄是RICU患者鲍曼不动杆菌感染的独立危险因素。3.严格执行无菌操作及感染控制规范,增强对高风险患者的重视,提高医务工作者对院感及APACHE Ⅱ评分的认识、加强抗菌药物临床管理等是预防和控制鲍曼不动杆菌感染的重要措施。
[Abstract]:Background: Acinetobacter Bauman is no fermented sugar gram-negative bacilli. It is widely distributed in nature, human skin and hospital environment. It belongs to the condition pathogenic bacteria and can survive in natural environment and human surface for a long time. Acinetobacter Bauman has strong cloning and transmission ability and acquired resistance, widespread resistance, all resistance and multidrug resistance. Acinetobacter Bauman has become a worldwide popular trend. Hospital acquired pneumonia, abdominal infection, urinary tract infection, blood flow infection, skin soft tissue infection, and Acinetobacter Bauman infection in central nervous system have become one of the important pathogens of nosocomial infection. China CHINET surveillance network of bacterial resistance in 2010 The data showed that of the gram negative bacteria isolated from 14 comprehensive teaching hospitals in 10 provinces and cities in 10 provinces and cities in China, Acinetobacter accounted for 16.11%, only after Escherichia coli and Klebsiella pneumoniae. The main risk factors for Acinetobacter Bauman infection were long hospitalization time, antibiotic exposure, mechanical ventilation and invasive exercise. In the case of infection, the patient's hospitalization time will be prolonged, the hospitalization costs are increased, and the mortality of the patients is increased. Therefore, the infection and drug resistance of Acinetobacter Bauman have aroused the widespread concern of the medical staff. The results of microbiological culture and clinical diagnosis and treatment of the patients were studied and analyzed to evaluate the infection and drug resistance of Acinetobacter Bauman in the hospital, and to compare the influence of sex, age, basic disease, APACHE II score, invasive operation on the infection rate of Acinetobacter, and find abalone through multiple factor Logistic regression analysis. The risk factors of Acinetobacter mantra infection and the corresponding OR value in order to explore the prevention and isolation measures of Acinetobacter Bauman infection. Data and methods: a retrospective analysis of 264 patients in the respiratory internal care unit (RICU) of a three a comprehensive hospital, 2010, was reviewed, and the case inquiry system of the hospital was collected and collected. The clinical data of these patients included laboratory microbiological examination results of various specimens, demographic data, acute physiology and chronic health status score system II (APACHE II) score, combined underlying disease, invasive operation, drug use, bacterial resistance, prognosis, etc. To evaluate the infection rate and drug resistance of Acinetobacter Bauman in RICU patients in this hospital, to analyze the situation of mixed infection in RICU Bauman Acinetobacter infection, compare the influence of gender, age, invasive operation, basic disease and APACHE II score on the infection rate of Acinetobacter Bauman, and explore the risk factors for the infection of Acinetobacter Bauman in the RICU patients. And the corresponding OR value, further explore the prevention and isolation measures of the infection of Acinetobacter Bauman. Statistical method: the comparison of the data was compared with t test (normal distribution) or rank sum test (non normal distribution), and a chi square test was used to compare the count data. Multi factor Logistic back analysis of the classified data was used. According to the analysis, the corresponding OR value and its 95% confidence interval were calculated, and the regression coefficient was tested by Wald test. The difference was statistically significant. The main result: a total of 264 cases of RICU hospitalized patients were collected, including 160 men, 104 women, 33-92 years old and 67.3 years old. The total infection rate was 27.65%, and the rate of male infection was 28.75%, The correlation analysis of female 25.96%. infection rate and APACHE II score: the infection rate of Acinetobacter Bauman in RICU patients was positively correlated with the APACHE II score, and the correlation coefficient r.=0.9632. was analyzed by Logistic regression analysis. The independent risk factors for the infection of Acinetobacter in RICU patients were traumatic operation (OR=4.257), fungal infection (OR=3.782), APACHE. II score (OR=2.532), combined with basic disease (OR=2.104), age (OR=1.812). Conclusions and suggestions: 1. the infection rate of Acinetobacter Bauman in the RICU patients in this hospital is higher, the drug resistance situation is severe.2. invasive operation, fungal infection, APACHE II score, combined with basic disease, and the high age is the independent risk factor of Acinetobacter infection of Acinetobacter in RICU patients.3. strictly It is an important measure to prevent and control the infection of Acinetobacter Bauman by implementing the standard of aseptic operation and infection control, enhancing the attention to the high-risk patients, improving the awareness of hospital workers' sense of hospital and the score of APACHE II, and strengthening the clinical management of antibiotics.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R446.5

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