| 田 梅,周 媛,周 敏,郭 楠,任黎妍.ICU下呼吸道多重耐药菌医院感染的病原学临床特征及易感因素分析[J].现代生物医学进展英文版,2023,(18):3645-3469. |
| ICU下呼吸道多重耐药菌医院感染的病原学临床特征及易感因素分析 |
| Pathogenic Clinical Characteristics and Susceptibility of Nosocomial Infection of Multi-drug Resistant Bacteria in ICU Lower Respiratory Tract |
| Received:March 07, 2023 Revised:March 31, 2023 |
| DOI：10.13241/j.cnki.pmb.2023.18.012 |
| 中文关键词: ICU 下呼吸道 多重耐药菌 |
| 英文关键词: ICU Lower respiratory tract Multidrug-resistant bacteria |
| 基金项目:新疆维吾尔自治区自然科学基金项目（2022D01C132） |
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| 中文摘要: |
| 摘要 目的：研究ICU下呼吸道多重耐药菌医院感染的病原学临床特征及易感因素。方法：选择2020年1月到2022年12月于我院ICU住院治疗的216例下呼吸道感染者，按照是否发生多重耐药菌感染分为研究组113例，对照组103例。分析两组患者感染相关因素的数量分布情况，通过Logistic回归分析多重耐药菌医院感染的危险因素。采用全自动细菌鉴定仪对菌种进行鉴定，采用K-B纸片法进行药敏试验，并分析多重耐药菌感染的病原学分布及对常用抗菌药物的耐药性。结果：（1）与对照组相比，研究组患者感染相关因素的分布率更高；（2）住院时间>3个月、使用糖皮质激素治疗、应用机械通气治疗、其他细菌感染、血红蛋白含量<100 g/L、抗菌药物使用时间>15 d、抗菌药物使用种类>4种、使用免疫抑制剂是ICU下呼吸道多重耐药菌感染的危险因素；（3）113例研究组共培养出细菌菌株93株，其中革兰氏阴性菌52株（55.91%），革兰氏阳性菌25株（26.88%），革兰氏阴性菌中较多的是铜绿假单胞菌（22株）、鲍曼不动杆菌（13株）、肺炎克雷伯菌（12株）；革兰氏阳性菌中最多的是肺炎链球菌（11株）和金黄色葡萄球菌（11株）；（4）耐药情况：铜绿假单胞菌对莫西沙星耐药率较低（15.83%），肺炎克雷伯菌对亚胺培南耐药率较低（17.56%），鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率较低（16.37%），金黄色葡萄球菌、肺炎链球菌对万古霉素无耐药性。结论：住院时间>3个月、使用糖皮质激素治疗、应用机械通气治疗、其他细菌感染、血红蛋白含量<100 g/L、抗菌药物使用时间>15 d、抗菌药物使用种类>4种、使用免疫抑制剂是多重耐药感染的独立危险因素。本院ICU下呼吸道感染以革兰氏阴性杆菌为主，应根据病原菌选择耐药性低的药物，并针对危险因素采取有效措施。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the pathogenic clinical characteristics and susceptibility factors of multi-drug resistant bacteria in ICU lower respiratory tract. Methods: A total of 216 patients with lower respiratory tract infection who were hospitalized in ICU of our hospital from January 2020 to December 2022 were selected and divided into study group (113 cases) and control group (103 cases) according to whether multiple drug resistant bacteria infection occurred. The number distribution of infection-related factors in the two groups was analyzed, and the risk factors of nosocomial infection of multi-drug resistant bacteria were analyzed by Logistic regression. The bacterial species were identified by automatic bacterial identification instrument, and the drug sensitivity test was carried out by K-B disk method. The pathogenic distribution and drug resistance of multi-drug resistant bacterial infection were analyzed. Results: (1) Compared with the control group, the distribution rate of infection-related factors was higher in the study group; (2) Duration of hospital >3 months, glucocorticoid therapy, mechanical ventilation therapy, other bacterial infections, hemoglobin <100 g/L, antibacterial drug use time >15 days, antibacterial drug types > 4, immunosuppressant were the risk factors of multiple drug-resistant bacterial infection in ICU lower respiratory tract; (3) 93 strains of bacteria were cultured in the study group, of which 52 (55.91%) were Gram-negative, 25 (26.88%) were Gram-positive, and most of the gram-negative bacteria were Pseudomonas aeruginosa (22), Acinetobacter baumannii (13) and Klebsiella pneumoniae (12). The most gram-positive bacteria were Streptococcus pneumoniae (11 strains) and Staphylococcus aureus (11 strains). (4) Drug resistance showed that the resistance rate of Pseudomonas aeruginosa to moxifloxacin was low (15.83%), that of Klebsiella pneumoniae to imipenem was low (17.56%), that of Acinetobacter baumannii to cefoperazone/sulbactam was low (16.37%), and staphylococcus aureus and streptococcus pneumoniae showed no resistance to vancomycin. Conclusion: Hospital stay >3 months, glucocorticoid therapy, mechanical ventilation therapy, other bacterial infections, hemoglobin <100 g/L, antibacterial drug use >15 days, types of antibacterial drugs >4, immunosuppressants are independent risk factors for multidrug-resistant infections. In this hospital, Gram-negative bacilli were dominant in ICU lower respiratory tract infections, so drugs with low drug resistance should be selected according to the pathogenic bacteria, and effective measures should be taken according to the risk factors. |
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