摘要
目的探究重症加强护理病房(intensive care unit,ICU)脑卒中相关性肺炎(stroke associated pneumonia,SAP)患者病原菌构成及多药耐药菌(multidrug resistant bacteria,MDRO)感染的影响因素。方法选取2015年3月-2018年9月于西南医科大学附属医院ICU进行住院治疗的SAP患者160例为研究对象,回顾性分析患者临床资料,分析患者感染病原学特点,单因素及多因素Logistic回归分析患者MDRO感染的影响因素。结果 160例SAP患者其中MDRO感染112例,共检出MDRO 154株,其中革兰阴性菌105株,占68.18%,以铜绿假单胞菌、鲍氏不动杆菌和肺炎克雷伯菌为主。革兰阳性菌39株,占25.32%,以金黄色葡萄球菌、溶血性葡萄球菌为主。革兰阴性菌对大多数抗菌药物耐药,对亚胺培南、妥布霉素敏感性较好,革兰阳性菌对莫西沙星、万古霉素和替考拉宁敏感性较好。晚发型SAP、合并糖尿病、嗜睡、使用气管插管、尿管、胃管、未预防性使用抗菌药物、长时间的机械通气和ICU住院时间是导致感染MDRO的影响因素。结论 ICU中SAP患者MDRO感染率较高,其耐药性严重。入侵性操作、患者意识障碍程度高、糖尿病、长时间的ICU住院时间均可能提高感染MDRO的风险。
OBJECTIVE To explore the species of pathogens isolated from the intensive care unit(ICU) patients with stroke-associated pneumonia(SAP) and analyze the influencing factors for multidrug-resistant organisms(MDROs) infections. METHODS A total of 160 patients with SAP who were hospitalized in the ICUs of Affiliated Hospital of Southwest Medical University from Mar 2015 to Sep 2018 were recruited as the study objects, the clinical data of the patients were retrospectively analyzed, the etiological characteristics of the infections were observed, and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the MDROs infections. RESULTS Of the 160 patients with SAP, 112 had MDROs infections.Totally 154 strains of MDROs were isolated, 105(68.18%) of which were gram-negative bacteria, 39(25.32%) were gram-positive bacteria;Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were the predominant species of the gram-negative bacteria;Staphylococcus aureus and Staphylococcus haemolyticus were dominant among the gram-positive bacteria.The gram-negative bacteria were resistant to most of the antibiotics and were highly susceptible to imipenem and tobramycin;the gram-positive bacteria were highly susceptible to moxifloxacin, vancomycin and teicoplanin.Late-onset SAP, complication with diabetes mellitus, sleepiness, endotracheal intubation, urinary catheter, gastric tube, prophylactic use of antibiotics, long-term mechanical ventilation and length of ICU stay were the influencing factors for the MDROs infections. CONCLUSION The incidence of MDROs infections is high among the ICU patients with SAP, and the strains are highly drug-resistant.The invasive procedures, high grade of disturbance of consciousness, diabetes mellitus and long length of ICU stay may increase the risk of MDROs infections.
作者
赵丽娜
雷贤英
高晓岚
卢昌碧
艾中平
ZHAO Li-na;LEI Xian-ying;GAO Xiao-lan;LU Chang-bi;AI Zhong-ping(Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第1期67-71,共5页
Chinese Journal of Nosocomiology
