医院神经外科感染多重耐药菌的临床分布及危险因素分析
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摘要
目的探讨神经外科多重耐药菌(multi drug resistent organisms,MDROs)感染的临床特征及相关危险因素,为临床MDRO感染的预防及控制提供依据。方法回顾性研究2012年1月到2016年12月贵州医科大学第三附属医院神经外科住院患者发生感染276例,根据是否检出MDROs,分为MDROs组及非MDROs组,记录其临床资料,并对其引起MDROs感染的可能相关危险因素分别进行单因素与多因素Logistic模型回归分析。结果 MDROs感染率35.51%,MDROs菌株检出率为33.23%。菌种以ESBLs、CR-AB和MRSA多见;感染部位以下呼吸道、泌尿道和切口感染为主。多因素Logistic回归分析显示,住院时间>20 d、意识水平(昏迷)、入住ICU≥7 d、通气方式(有创)、先后更换抗菌药物种数≥3种、联合使用抗菌药物≥3种、机械通气时间≥7 d等是神经外科患者MDROs感染的可能危险因素(P<0.05)。结论神经外科MDROs感染形势严峻。缩短不必要的住院时间,及时评估尽早转出ICU,提高微生物送检,避免反复更换或大包围用药,减少不必要机械通气时间,病情允许时尽可能改为无创通气,重点关注意识水平差的患者,防止误吸等是减少MDROs感染的重要措施。
Objective To investigate the clinical features and risk factors of multidrug-resistant bacteria(multi drug resistant organisms, MDROs) infection in Department of Neurosurgery, and to provide evidence for the prevention and control of MDRO infection. Methods Data from 437 cases of infection in hospitalized patients on January 2012-2016 year in December Third Affiliated Hospital of Guizhou Medical University were retrospectively analyzed. Patients were divided into MDROs group and non MDROs group based on the results of MDROs detection. Multi factor Logistic regression analysis model was used to analyze risk factors. Results The infection rate of MDROs was 35.51%, and the detection rate of MDROs was 33.23%. ESBLs, CR-AB and MRSA were the most common bacterial species, and the infection of respiratory tract, urinary tract and wound infection were the main infection sites. Multivariate logistic regression analysis showed that hospitalization time >20 d, level of consciousness(coma), occupancy of ICU ≥7 d,ventilation(invasive), number of antibiotics used ≥3, combined use of antibiotics ≥3, mechanical ventilation Time ≥7 d were possible risk factors for MDROs infection in neurosurgical patients(P<0.05). Conclusion The situation of MDROs infection in neurosurgery is severe. To reduce MDROs infection, it is important to shorten unnecessary hospitalization time, promptly assess and transfer out of ICU as soon as possible, improve microbial examination, avoid frequent change of antibiotics or unnecessary use of use of broad-spectrum antibiotics, reduce unnecessary mechanical ventilation time,change to non-invasive ventilation as far as possible when the condition permits, focus on patients with poor consciousness, and prevent aspiration by mistake.
Objective To investigate the clinical features and risk factors of multidrug-resistant bacteria(multi drug resistant organisms, MDROs) infection in Department of Neurosurgery, and to provide evidence for the prevention and control of MDRO infection. Methods Data from 437 cases of infection in hospitalized patients on January 2012-2016 year in December Third Affiliated Hospital of Guizhou Medical University were retrospectively analyzed. Patients were divided into MDROs group and non MDROs group based on the results of MDROs detection. Multi factor Logistic regression analysis model was used to analyze risk factors. Results The infection rate of MDROs was 35.51%, and the detection rate of MDROs was 33.23%. ESBLs, CR-AB and MRSA were the most common bacterial species, and the infection of respiratory tract, urinary tract and wound infection were the main infection sites. Multivariate logistic regression analysis showed that hospitalization time >20 d, level of consciousness(coma), occupancy of ICU ≥7 d,ventilation(invasive), number of antibiotics used ≥3, combined use of antibiotics ≥3, mechanical ventilation Time ≥7 d were possible risk factors for MDROs infection in neurosurgical patients(P<0.05). Conclusion The situation of MDROs infection in neurosurgery is severe. To reduce MDROs infection, it is important to shorten unnecessary hospitalization time, promptly assess and transfer out of ICU as soon as possible, improve microbial examination, avoid frequent change of antibiotics or unnecessary use of use of broad-spectrum antibiotics, reduce unnecessary mechanical ventilation time,change to non-invasive ventilation as far as possible when the condition permits, focus on patients with poor consciousness, and prevent aspiration by mistake.
引文
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[13]RYBTKE MT,JENSEN P,HIBY N,et al.The implication of Pseudomonas aeruginosa biofilms in infections[J].Inflamm Allergy Allergy Drug Targets,2011,10(2):141-157.
[2]李春辉,吴安华.医疗机构耐药菌MDR、XDR、PDR的国际标准化定义专家建议(草案)[J].中国感染控制杂志,2011,(3):238-240.
[3]胡美春,王莉宁,梁小英.某院2012年多重耐药菌分布及耐药性[J].中国感染控制杂志,2014,13(2):89-92.
[4]王芬.临床分离多重耐药菌感染特点及耐药性目标性监测[J].中国消毒学杂志,2016,33(8):780-782.
[5]钟韵,陈奕慧.某医院临床多重耐药菌分布及细菌耐药性分析[J].中国消毒学杂志,2016,33(12):1212-1214.
[6]赵红霞,轩凯.临床分离多重耐药菌感染类型及变化趋势[J].中国感染控制杂志.2014,13(6):371-373.
[7]李秀英,路珊珊.某医院多重耐药菌目标性监测和感染现状分析[J].中国消毒学杂志,2019,36(2):136-138.
[8]沈云龙,刘加令,漆松涛,等.脑室出血外引流术后继发颅内感染危险因素分析[J].中国神经精神疾病杂志,2015,41(12):705-709.
[9]李娇,商临萍,郭红菊,等.综合ICU多重耐药菌医院感染的风险模型构建[J].中国感染控制杂志,2016,15(10):730-734.
[10]谢朝云,闫飞,熊永发,等.骨科开放伤口多重耐药菌感染危险因素的Logistic回归分析[J].中国矫形外科杂志,2017,25(2):108-113.
[11]CHADI SA,KIDANE B,BRITTO K,et al.Incisional negativepressure wound therapy decreases the frequency of postoperative perineal surgical site infections:a cohort study[J].Dis Colon Rectum,2014,57(8):999-1006.
[12]张倩,彭燕,相文,等.某医院抗菌药物临床使用与多重耐药菌感染监测分析[J].人民军医,2018,61(11):1021-1025,1034.
[13]RYBTKE MT,JENSEN P,HIBY N,et al.The implication of Pseudomonas aeruginosa biofilms in infections[J].Inflamm Allergy Allergy Drug Targets,2011,10(2):141-157.