摘要
目的分析ICU多重耐药菌感染的现况和危险因素,为临床预防和控制多重耐药菌提供指导。方法2015-2018年南京明基医院入住ICU患者,观察院内感染和多重耐药菌(MDRO)感染情况,分析标本来源、感染部位,对耐碳青霉烯类抗生素鲍曼不动杆菌(CR-AB)进行药敏及危险因素分析。结果ICU院内感染408例次,MDRO感染127例次(31.3%),感染部位集中在呼吸道、血流和泌尿道,前5位是CR-AB、耐碳青霉烯类抗生素肠杆菌科细菌(CRE)、甲氧西林金黄色葡萄球菌(MRSA)、多重耐药/泛耐药铜绿假单胞菌(MDR/PDR-PA)、MRCNS;导管相关的医院感染[呼吸机相关性肺炎(VAP)、中央导管相关血流感染(CRBSI)、尿管相关泌尿道感染(CAUTI)]59.31%(242/408),其中MDRO感染33.1%(80/242)。MDRO感染中革兰阴性94株(74.0%),革兰阳性33株(26.0%),革兰阳性菌和革兰阴性菌在痰标本、血标本、VAP、CRBSI中分布差异有统计学意义(P<0.01)。MDRO感染中检出CRAB 48株,检出率为37.8%(48/127),药敏分析结果显示,CR-AB敏感性前4名是左氧氟沙星25株(52.1%),复方新诺明19株(39.6%),米诺环素18株(37.5%),头孢哌酮/舒巴坦12株(31.0%),其余均耐药。单因素分析显示,年龄、入住ICU病房次数、留置中央静脉导管(CVC)时间是CR-AB的危险因素,差异有统计学意义(P<0.05);Logistic多因素回归分析显示,留置CVC时间(OR=0.96,95%CI:0.92~1.00)为CR-AB的独立危险因素,差异有统计学意义(P<0.05)。结论ICU院内感染中MDRO发生率高,主要为革兰阴性杆菌,CR-AB检出率高,耐药性强。临床要重视两管一机监测,评估导管留置必要性及缩短留置时间,做好多重耐药菌预防和控制工作。
Objective To analyze current status and risk factors of multidrug-resistant organism(MDRO)infections in ICU,and provide guidance for clinical prevention and control of MDRO.Methods from 2015 to 2018,ICU patients were admitted to a tertiary hospital,and the hospital-acquired infection and MDRO infection were observed.The source and infection site of specimens were analyzed,and drug sensitivity and risk factors of CR-AB were analyzed.Results There were 408 cases of ICU hospital infection;in which,127 cases were MDRO infection(31.3%).The infection site was concentrated in the respiratory tract,blood flow and urinary tract.The top 5 pathogens were CR-AB,carbapenem-resistant antibiotics Enterobacteriaceae(CRE),methicillin-resistant Staphylococcus aureus(MRSA),multi-drug/pan-resistant Pseudomonas aeruginosa(MDR/PDR-PA)and MRCNS.Catheter-related nosocomial infections[ventilator-associated pneumonia(VAP),central catheter-related bloodstream infection(CRBSI),catheter-related urinary tract infection(CRUTI)]were 59.31%,of which MDRO infection was 33.1%(80/248).In the MDRO infection,94 strains(74.0%)were Gram-negative,and 33 strains(26.0%)were Gram-positive.There were significant differences in the distribution of Gram-positive and Gram-negative bacteria in sputum specimens,blood specimens,VAP and CRBSI(P<0.01).48 strains of CR-AB were detected in MDRO infection,and the detection rate was 37.8%(48/127).The results of drug sensitivity analysis showed that the top 4 CR-AB sensitive drugs were levofloxacin(25,52.1%),sulfamethoxazole(19,39.6%),minocycline(18,37.5%),and cefoperazone/shu Bataan(12,31.0%),while the rest were resistant.Univariate analysis showed that age,number of stays in ICU wards,and CVC retention time were risk factors for CR-AB infection(P<0.05).Logistic multivariate regression analysis showed that the time of indwelling CVC(OR=0.96,95%CI:0.92~1.00)was an independent risk factor for CR-AB infection(P<0.05).Conclusions The incidence of MDRO in ICU hospital infection was high;the pathogens were mainly Gram-negative bacilli;CR-AB detection rate was high,and drug resistance was strong.Clinically,it is necessary to evaluate the necessity of catheter retention and shorten the retention time,and to do the prevention and control of multi-drug resistant bacteria.
作者
熊兴林
潘俊辰
顾艮莹
许勤
XIONG Xing-lin;PAN Jun-chen;GU Gen-ying;XU Qin(Department of ICU,Nanjing BenQ Hospital,the Affiliated BenQ Hospital of Nanjing Medical University,Nanjing,Jiangsu 210019;Nanjing Medical University,Nanjing,Jiangsu 210029,China)
出处
《热带医学杂志》
CAS
2019年第10期1254-1256,1270,共4页
Journal of Tropical Medicine
基金
国家临床重点专科建设项目(2011873).
