重症监护病房呼吸机相关性肺炎多重耐药非发酵菌的感染情况及相关高危因素分析
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摘要
目的:对重症监护病房(ICU)呼吸机相关性肺炎发生多重耐药非发酵菌感染情况进行分析,并探讨相应的危险因素。方法:纳入2016-04—2017-05期间我院重症监护病房住院期间发生呼吸机相关性肺炎的107例患者资料,对患者临床一般资料收集整理,并在ICU病房机械通气48 h后均采集痰标本进行菌种鉴定及药敏试验,并根据患者是否为多重耐药非发酵菌感染分为实验组与对照组,通过组间比较与多因素Logistic回归分析,探讨患者发生多重耐药非发酵菌感染的相关危险因素。结果:107例患者中多重耐药非发酵菌感染者占比59.81%,共分离出菌株69株,以铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽食单胞菌、洋葱伯克霍尔菌为主。与对照组发酵菌感染者一般资料组间比较,联合多因素Logistic回归分析认为,气管切开、ICU住院≥7 d、呼吸机使用≥7 d、院内感染时间≥7 d、经验性用药、合并慢阻肺、碳青霉烯类应用,与多重非发酵菌感染呈正相关(P<0.05)。结论:重症监护病房呼吸机相关性肺炎患者发生多重耐药非发酵菌感染十分常见,临床需提高重视,加强对高危因素的控制,尽可能降低发生率及病死率。
Objective: To analyze the multi-resistant non-fermentative bacteria infection and risk factors of ventilator-associated pneumonia in intensive care unit. Method: A total of 107 patients with ventilator-associated pneumonia who were hospitalized during the hospitalization from April 2016 to May 2017 in the ICU were enrolled in this study. The general clinical data were collected. Sputum samples were collected 48 hours after ICU for ward ventilation Bacteria identification and drug susceptibility testing, and according to whether the patients are multi-drug resistant non-fermentative bacteria were divided into experimental group and control group, by comparing between groups and multivariate Logistic regression analysis to explore the occurrence of multi-drug resistant non-fermentive bacterial infections Related risk factors. Result: In the 107 patients, 59.81% were infected with multidrug-resistant non-fermentative bacteria. A total of 69 strains were isolated, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia were the main bacteria. Logistic regression analysis showed that tracheotomy, ICU hospitalization 7 d, ventilator use ≥7 d, nosocomial infection time ≥7 d, empirical medication, combined with chronic obstructive pulmonary disease, The application of carbapenems was positively correlated with multiple non-fermentative bacterial infections(P<0.05). Conclusion: It is very common in patients with ventilator-associated pneumonia in intensive care unit that multiple drug-resistant non-fermentative bacterial infections occur. Therefore, it is necessary to pay more attention to clinical treatment and to strengthen the control of risk factors so as to reduce the incidence and mortality.
Objective: To analyze the multi-resistant non-fermentative bacteria infection and risk factors of ventilator-associated pneumonia in intensive care unit. Method: A total of 107 patients with ventilator-associated pneumonia who were hospitalized during the hospitalization from April 2016 to May 2017 in the ICU were enrolled in this study. The general clinical data were collected. Sputum samples were collected 48 hours after ICU for ward ventilation Bacteria identification and drug susceptibility testing, and according to whether the patients are multi-drug resistant non-fermentative bacteria were divided into experimental group and control group, by comparing between groups and multivariate Logistic regression analysis to explore the occurrence of multi-drug resistant non-fermentive bacterial infections Related risk factors. Result: In the 107 patients, 59.81% were infected with multidrug-resistant non-fermentative bacteria. A total of 69 strains were isolated, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia were the main bacteria. Logistic regression analysis showed that tracheotomy, ICU hospitalization 7 d, ventilator use ≥7 d, nosocomial infection time ≥7 d, empirical medication, combined with chronic obstructive pulmonary disease, The application of carbapenems was positively correlated with multiple non-fermentative bacterial infections(P<0.05). Conclusion: It is very common in patients with ventilator-associated pneumonia in intensive care unit that multiple drug-resistant non-fermentative bacterial infections occur. Therefore, it is necessary to pay more attention to clinical treatment and to strengthen the control of risk factors so as to reduce the incidence and mortality.
引文
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[10] 方寅飞,徐浩,冯胜春.非发酵菌在重症监护病房患者中感染分布及其耐药性研究[J].中国消毒学杂志,2015,32(5):452-454.
[11] Patil HV,Patil VC.Incidence,bacteriology,and clinical outcome of ventilator-associated pneumonia at tertiary care hospital[J].J Nat Sci Biol Med,2017,8(1):46-55.
[12] 杜静,龙继川,李春辉.基层医院ICU与非ICU主要革兰阴性杆菌分布与耐药性差异[J].中国感染控制杂志,2015,14(7):468-471.
[13] 金妙玲,陈丹,周铁丽.肺结核合并非发酵菌下呼吸道感染的临床特征及耐药性分析[J].中国微生态学杂志,2014,26(4):444-447.
[14] Aslam S,Saji D.Antimicrobial potential of Halophilic actinomycetes against multi drug resistant(MDR)ventilator associated pneumonia causing bacterial pathogens[J].Pak J Pharm Sci,2016,29(2):367-374.
[15] 余伟鹏,冼美兰.慢性阻塞性肺疾病并发呼吸机相关性肺炎的痰培养菌种分布和细菌耐药分析[J].中国感染与化疗杂志,2015,15(6):538-541.
[16] 蔡静,许静洁,潘海燕.替加环素联合亚胺培南对多重耐药及泛耐药鲍曼不动杆菌体外抗菌作用[J].医药导报,2017,36(2):149-153.
[2] 余虹.某医院呼吸机相关肺炎危险因素研究[J].中国消毒学杂志,2015,32(4):357-359.
[3] 夏维,严洁,毛文君.ICU呼吸机相关性肺炎危险因素分析[J].临床肺科杂志,2016,21(3):495-497.
[4] 李淑媛,盖鑫,张建,等.ICU机械通气患者呼吸机相关性肺炎危险因素与干预措施[J].中华医院感染学杂志,2016,26(1):76-78.
[5] 张越伦,韩立中,杨智荣,等.多中心多重耐药菌医院感染肺炎危险因素研究[J].中国感染控制杂志,2014,13(9):513-517.
[6] Tseng SP,Hung WC,Huang CY,et al.5-Episinuleptolide Decreases the Expression of the Extracellular Matrix in Early Biofilm Formation of Multi-Drug Resistant Acinetobacter baumannii[J].Mar Drugs,2016,29(8):14.
[7] 刘文娟,李敏,赵娜,等.双坡三联活菌对机械通气患者发生呼吸机相关性肺炎的影响[J].医药导报,2016,35(1):50-53.
[8] Shojaeil L,Mohammadi M,Beimohammadi MT,et al.Clinical response and outcome of pneumonia due to multi-drug resistant Acinetobacter baumannii in critically ill patients[J].Iran J Microbiol,2016,8(5):288-297.
[9] 纪风兵,刘刚.重症监护病房卒中相关性肺炎发生非发酵菌感染的危险因素及耐药性研究[J].临床内科杂志,2016,33(1):36-39.
[10] 方寅飞,徐浩,冯胜春.非发酵菌在重症监护病房患者中感染分布及其耐药性研究[J].中国消毒学杂志,2015,32(5):452-454.
[11] Patil HV,Patil VC.Incidence,bacteriology,and clinical outcome of ventilator-associated pneumonia at tertiary care hospital[J].J Nat Sci Biol Med,2017,8(1):46-55.
[12] 杜静,龙继川,李春辉.基层医院ICU与非ICU主要革兰阴性杆菌分布与耐药性差异[J].中国感染控制杂志,2015,14(7):468-471.
[13] 金妙玲,陈丹,周铁丽.肺结核合并非发酵菌下呼吸道感染的临床特征及耐药性分析[J].中国微生态学杂志,2014,26(4):444-447.
[14] Aslam S,Saji D.Antimicrobial potential of Halophilic actinomycetes against multi drug resistant(MDR)ventilator associated pneumonia causing bacterial pathogens[J].Pak J Pharm Sci,2016,29(2):367-374.
[15] 余伟鹏,冼美兰.慢性阻塞性肺疾病并发呼吸机相关性肺炎的痰培养菌种分布和细菌耐药分析[J].中国感染与化疗杂志,2015,15(6):538-541.
[16] 蔡静,许静洁,潘海燕.替加环素联合亚胺培南对多重耐药及泛耐药鲍曼不动杆菌体外抗菌作用[J].医药导报,2017,36(2):149-153.