血流感染及革兰阴性杆菌感染对糖尿病重症患者的影响

发布时间：2018-03-08 08:55

本文选题：血流感染　切入点：死亡　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.探讨糖尿病重症患者死亡及发生血流感染的风险因素2.分析糖尿病重症患者主要革兰阴性杆菌分布及耐药性。方法:1.收集我院2014年6月至2016年5月入住ICU重症病例105例。纳入标准:行有创机械通气时间≥48小时,住院时间≥72小时。比较糖尿病重症患者与非糖尿病重症患者死亡之间的关系,分析ICU重症患者死亡的风险因素。比较糖尿病重症患者与非糖尿病重症患者发生血流感染之间的关系,分析ICU重症患者发生血流感染的风险因素。2.分析我院ICU 2015年1月至2017年1月2年期间危重患者的革兰氏阴性杆菌的分布和耐药情况。结果:1.与ICU非糖尿病危重病人死亡率相比,糖尿病危重病人死亡率高(χ2=4.57 P0.05)。可见糖尿病是ICU危重患者死亡的危险因素之一。年龄、APACHE II评分、高血压、心血管疾病、慢性肾脏疾病、肠外营养、脓毒血症均是危重病人死亡的危险因素,差异有统计学意义(P0.05)。在多变量分析中,ICU危重病人死亡的独立风险因素是脓毒血症和肠外营养。与ICU非糖尿病危重病人血流感染发生率相比,糖尿病危重病人血流感染发生率高(χ2=3.94 P0.05)。可见糖尿病同时也是ICU危重病人发生血流感染的风险因素。年龄、BMI、APACHEⅡ评分、性别、糖尿病病程、Hb A1C≥7%、心血管疾病、脑卒中、慢性肾脏疾病、既往血流感染史、高血压均是危重病人发生血流感染的危险因素,差异无统计学意义(P0.05)。在单变量分析中,糖尿病、脑卒中、既往血流感染史比较差异有统计学意义(P0.05)。在多变量分析中,ICU危重病人发生血流感染的独立危险因素是脑卒中和既往血流感染史。2.收集本院2015年1月至2017年1月入住ICU重症病人分离出的革兰氏阴性杆菌213株,其中糖尿病重症患者74株,非糖尿病重症患者139株,好发于呼吸系统、泌尿系统、血液、胸腹腔积液等。主要致病菌依次为铜绿假单胞菌55株(25.82%),糖尿病重症患者15株,非糖尿病重症患者40株;肺炎克雷伯菌53株(24.88%),糖尿病重症患者26株,非糖尿病重症患者27株;鲍曼不动杆菌40株(18.78%),糖尿病重症患者15株,非糖尿病重症患者25株;大肠埃希杆菌23株(10.80%),糖尿病重症患者6株,非糖尿病重症患者17株。黏质沙雷菌10株(4.69%)糖尿病重症患者2株,非糖尿病重症患者8株;奇异变形菌7株(3.29%),糖尿病重症患者2株,非糖尿病重症患者5株;嗜麦芽窄食单胞菌7株(3.29%),糖尿病重症患者0株,非糖尿病重症患者7株;阴沟肠杆菌5株(2.34%),糖尿病重症患者3株,非糖尿病重症患者2株。其中多重耐药菌多见,共计51株(23.94%),此次研究2年来糖尿病患者组与非糖尿病患者组多重耐药率比较无统计学意义(χ2=2.53 P0.05)。比较亚胺培南和美罗培南的耐药率,铜绿假单胞菌分别为38.18%和21.82%,肺炎克雷伯菌分别为1.89%和26.42%,鲍曼不动杆菌分别为52.5%和95%。嗜麦芽窄食单胞菌虽对碳青霉烯类耐药率100%,但对复方磺胺甲VA唑和米诺环素的敏感率可以高达90%。结论:1.糖尿病是ICU重症患者死亡和发生血流感染的风险因素之一。ICU重症患者死亡的独立风险因素是脓毒血症和肠外营养。ICU重症患者发生血流感染的独立风险因素是脑卒中和血流感染史。2.控制糖尿病患者多重耐药革兰氏阴性杆菌感染非常重要,激励我们坚持或改善合理的抗生素治疗的原则,遵守合理的抗生素策略的原则为了保持细菌对至少那些仍然有效的抗生素的敏感性并且减缓抗生素抗性的增加而努力。
[Abstract]:Objective: To investigate 1. patients with diabetes mellitus and death risk factors of bloodstream infections in 2. patients with severe diabetes: analysis of main leather Distribution and drug resistance of gram negative bacillus. Methods: 1. cases were collected from June 2014 to May 2016 in our hospital 105 cases of severe ICU. Inclusion criteria: 48 hours for invasive mechanical ventilation over time, hospitalization time more than 72 hours comparison of the relationship between death in patients with severe diabetes and non diabetes patients, risk factors of mortality in patients with severe ICU. The relationship between the bloodstream infection of diabetic and non diabetic patients with severe occurrence of severe cases, analysis of risk factors of bloodstream infection occurred in patients with severe ICU.2. ICU in our hospital from January 2015 to January 2017 analysis of distribution and drug resistance during 2 years critically ill patients with Gram negative bacilli. Results: 1. ICU and mortality in patients with diabetes compared with non severe diabetes, critical illness People with high mortality (2=4.57 P0.05). The diabetes is one of the risk factors of death of ICU patients. Age, APACHE II score, hypertension, cardiovascular disease, chronic kidney disease, parenteral nutrition, sepsis were risk factors of death in critically ill patients, the difference was statistically significant (P0.05). In the multivariate analysis ICU, independent risk factors of death in critically ill patients is sepsis and parenteral nutrition. The incidence rate of blood flow in ICU patients compared with non diabetes infection, incidence of high blood flow in patients with diabetic severe infection (2=3.94 P0.05). See the risk factors of bloodstream infection in critically ill patients. Diabetes is also ICU age, BMI, APACHE II score, gender, duration of diabetes, Hb A1C = 7%, cardiovascular disease, stroke, chronic kidney disease, previous history of blood infections, hypertension are risk factors for bloodstream infection in critically ill patients, no difference Statistical significance (P0.05). In univariate analysis, diabetes, stroke, there was a significant difference between the history of bloodstream infections (P0.05). In multivariate analysis, ICU critically ill patients of independent risk factors for bloodstream infection is stroke and blood infections past history of.2. of our hospital from January 2015 to January 2017 ICU patients with isolated 213 strains of gram negative bacilli, 74 strains of diabetic patients with severe non diabetes patients, 139 strains occur in the respiratory system, urinary system, blood, ascites and pleural effusion. The main pathogenic bacteria in Pseudomonas aeruginosa 55 strains (25.82%), 15 diabetic patients with severe strains. Non diabetic patients with severe 40 strains; 53 strains of Klebsiella pneumoniae (24.88%), diabetic patients with severe non diabetes patients with 26 strains, 27 strains of Bauman Acinetobacter; 40 strains (18.78%), diabetic patients ofcritically 15 strains of non diabetic patients with severe 25 Strains of Escherichia coli; 23 strains (10.80%), diabetic patients with severe non diabetes patients with 6 strains, 17 strains of Serratia marcescens. 10 strains (4.69%) of patients with diabetes in 2 strains, 8 strains of non diabetic patients; Proteus mirabilis 7 strains (3.29%), 2 diabetic patients with severe non diabetic patients with severe strains. 5 strains; Stenotrophomonas maltophilia 7 strains (3.29%), 0 diabetic patients with severe non diabetic patients with severe strains, 7 strains; 5 strains of Enterobacter cloacae (2.34%), 3 diabetic patients with severe non diabetic patients with severe strains, 2 strains of multidrug-resistant bacteria. The more common, a total of 51 strains (23.94% the study of 2 years), patients with diabetes and non diabetes patients with multi drug resistant rate was not statistically significant (2=2.53 P0.05). The resistance rate of imipenem and meropenem imipenem and Pseudomonas aeruginosa were 38.18% and 21.82%, Klebsiella pneumoniae were 1.89% and 26.42% respectively, Bauman Acinetobacter 52.5% and 95%. stenotrophomonasmaltophilia although the carbapenem resistance rate of 100%, but the sensitivity rate to VA triazole compound sulfamethoxazole and minocycline can be as high as 90%. conclusion: 1. ICU patients with severe diabetes is an independent risk factor for the occurrence and death of death risk factors of.ICU in patients with severe sepsis is bloodstream infection toxemia and parenteral nutrition in patients with severe.ICU independent risk factors for bloodstream infection is the history of.2. control of diabetes mellitus patients with multi drug resistant gram negative bacillus infection is very important infection of stroke and blood flow, we adhere to the incentive or improve the reasonable antibiotic treatment principle, abide by the reasonable strategy in order to maintain the principle of antibiotic bacteria to increase at least those who are still effective antibiotic sensitivity and reduce antibiotic resistance.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R459.7

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