呼吸危重症患者下呼吸道多药耐药菌感染危险因素分析

发布时间：2018-04-27 10:49

本文选题：呼吸危重症监护患者 + 多药耐药菌　；参考：《中华医院感染学杂志》2017年19期

【摘要】：目的分析呼吸危重症监护(RICU)患者下呼吸道多药耐药菌(MDRO)感染病原学及危险因素。方法回顾性分析医院2013年2月-2016年1月RICU收治的528例患者,统计发生下呼吸道MDRO感染患者和未发生下呼吸道MDRO感染患者的一般情况,采用单因素分析患者发生下呼吸道MDRO感染的相关因素,采用多因素logistic分析发生下呼吸道MDRO感染的危险因素,对下呼吸道MDRO感染的患者的病原学资料进行分析。结果 528例呼吸危重症监护患者共发生下呼吸道MDRO感染48例,感染率9.09%;29例患者为单一MDRO感染,19例患者为混合MDRO感染;MRSA对头孢类抗菌药物、青霉素类、氟喹诺酮类耐药,对碳青霉烯类、氨基糖苷类相对敏感,MDR/PDR-PA对头孢类、青霉素类较为敏感,对氟喹诺酮类耐药,对碳青霉烯类、氨基糖苷类耐药率较高,NDM-1肺炎克雷伯菌对头孢类抗菌药物、青霉素类、氨基糖甙类耐药性高,对氟喹诺酮类耐药、碳青霉烯类药物较为敏感;原发疾病、入住RICU2周、年龄65岁、免疫功能低下、更换抗菌药物次数3次、多人病房为RICU患者并发下呼吸道MDRO感染的独立危险因素。结论临床应尽可能采用多种快速病原菌分析手段,指导治疗方案的选择,提高抗菌药物应用合理性,降低抗菌药物更换频次,提高RICU患者治疗的针对性,严格执行各项预防感染措施,避免病原菌产生多药耐药性。
[Abstract]:Objective to analyze the etiology and risk factors of lower respiratory multidrug resistance (MDR) infection in respiratory critical care unit (RICU) patients. Methods A retrospective analysis of 528 patients with RICU admitted in our hospital from February 2013 to January 2016 was performed. The general situation of patients with MDRO infection in lower respiratory tract and those without MDRO infection in lower respiratory tract were analyzed retrospectively. The etiological data of patients with lower respiratory tract MDRO infection were analyzed by univariate analysis and multivariate logistic analysis of the risk factors of MDRO infection in lower respiratory tract. Results there were 48 cases of lower respiratory tract MDRO infection in 528 patients with respiratory critical care. The infection rate was 9.09%. The infection rate was 9.09% and 29 cases were single MDRO infection. 19 cases were mixed with MDRO infection, which were resistant to cephalosporal antimicrobial agents, penicillin and fluoroquinolones. MDR / PDR-PA was more sensitive to cephalosporins, penicillin, fluoroquinolone, carbapenem and aminoglycoside than NDM-1 to cephalosporins. Penicillin, high aminoglycoside resistance, sensitive to fluoroquinolones, carbapenem, primary disease, 65 years old, age 65, low immune function, three times to change antibiotics. Multiple ward was an independent risk factor for MDRO infection in lower respiratory tract in patients with RICU. Conclusion as far as possible, many kinds of rapid pathogenic bacteria analysis methods should be used in clinic to guide the selection of treatment plan, to improve the rationality of antimicrobial application, to reduce the frequency of antibiotics replacement, and to improve the pertinence of treatment for RICU patients. Strictly implement various measures to prevent infection and avoid multidrug resistance of pathogenic bacteria.
【作者单位】：南阳市第一人民医院呼吸重症监护科;南阳市第一人民医院呼吸内一科;
【分类号】：R56

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