ICU脑外伤及脑血管病患者肺部感染的病原学特点及影响因素分析
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摘要
目的探讨重症监护病房(ICU)脑外伤及脑血管病患者肺部感染的病原菌分布及其耐药性,分析引起患者肺部感染的影响因素。方法选取2015年1月-2016年12月医院ICU收治的100例脑外伤及脑血管病并发肺部感染患者作为感染组,采集患者痰液标本进行病原菌的鉴定及药敏试验。另选取同期未发生肺部感染脑外伤及脑血管病患者100例作为未感染组,单因素及多因素logistic回归分析发生肺部感染的影响因素。结果 100例感染患者共检出病原菌147株,革兰阳性菌73株占49.7%、革兰阴性菌61株占41.5%,真菌13株占8.8%;革兰阴性菌主要以铜绿假单胞菌和鲍氏不动杆菌为主,对氨芐西林、磺胺甲噁唑/甲氧苄啶、头孢替坦和头孢唑林的耐药性较高,对妥布霉素和亚胺培南的耐药性较低;革兰阳性菌主要以金黄色葡萄球菌和表皮葡萄球菌为主,对红霉素、青霉素、阿莫西林和舒巴坦的耐药性较高,对呋喃妥因和万古霉素的耐药性较低;多因素logistic回归分析显示,APACHEⅢ评分和机械通气是ICU脑外伤及脑血管病并发肺部感染的独立影响因素。结论 ICU脑外伤及脑血管病患者要积极处理发生肺部感染的影响因素,合并肺部感染的患者以革兰阳性菌感染占比较高,应根据患者病原菌药敏结果进行针对性治疗。
OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from intensive care unit(ICU)patients with brain trauma and cerebrovascular diseases complicated with pulmonary infection and analyze the influencing factors for the pulmonary infection.METHODS Totally 100 brain trauma and cerebrovascular diseases patients complicated with pulmonary infection who were treated in ICU from Jan 2015 to Dec 2016 were assigned as the infection group,the sputum specimens were collected for culture of pathogens,the isolated pathogens were identified,the drug susceptibility testing was performed,meanwhile,100 brain trauma and cerebrovascular disease patients who did not have pulmonary infection were set as the non-infection group,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the pulmonary infection.RESULTS A total of 147 strains of pathogens were isolated from 100 patients with infection,73(49.7%)of which were gram-positive bacteria,61(41.5%)were gram-negative bacteria,and 13(8.8%)were fungi.Pseudomonas aeruginosa and Acinetobacter were dominant among the gram-negative bacteria and were highly resistant to ampicillin,sulfamethoxazole-trimethoprim,cefotetan and cefazolin,while the drug resistance rate to tobramycin and imipenem was low.Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria and were highly resistant to erythromycin,penicillin,amoxicillin and sulbactam,and the drug resistance rate to nitrofurantoin and vancomycin was low.The multivariate logistic regression analysis showed that APACHEⅢscore and mechanical ventilation were the independent influencing factors for the pulmonary infection in the ICU patients with brain trauma and cerebrovascular diseases.CONCLUSIONIt is necessary to attach great importance to the influencing factors for the pulmonary infection in the ICU patients with brain trauma and cerebrovascular diseases,the gram-positive bacteria are dominant among the pathogens causing the pulmonary infection,and the targeted drug therapy should be conducted based on the result of the drug susceptibility testing.
OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from intensive care unit(ICU)patients with brain trauma and cerebrovascular diseases complicated with pulmonary infection and analyze the influencing factors for the pulmonary infection.METHODS Totally 100 brain trauma and cerebrovascular diseases patients complicated with pulmonary infection who were treated in ICU from Jan 2015 to Dec 2016 were assigned as the infection group,the sputum specimens were collected for culture of pathogens,the isolated pathogens were identified,the drug susceptibility testing was performed,meanwhile,100 brain trauma and cerebrovascular disease patients who did not have pulmonary infection were set as the non-infection group,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the pulmonary infection.RESULTS A total of 147 strains of pathogens were isolated from 100 patients with infection,73(49.7%)of which were gram-positive bacteria,61(41.5%)were gram-negative bacteria,and 13(8.8%)were fungi.Pseudomonas aeruginosa and Acinetobacter were dominant among the gram-negative bacteria and were highly resistant to ampicillin,sulfamethoxazole-trimethoprim,cefotetan and cefazolin,while the drug resistance rate to tobramycin and imipenem was low.Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria and were highly resistant to erythromycin,penicillin,amoxicillin and sulbactam,and the drug resistance rate to nitrofurantoin and vancomycin was low.The multivariate logistic regression analysis showed that APACHEⅢscore and mechanical ventilation were the independent influencing factors for the pulmonary infection in the ICU patients with brain trauma and cerebrovascular diseases.CONCLUSIONIt is necessary to attach great importance to the influencing factors for the pulmonary infection in the ICU patients with brain trauma and cerebrovascular diseases,the gram-positive bacteria are dominant among the pathogens causing the pulmonary infection,and the targeted drug therapy should be conducted based on the result of the drug susceptibility testing.
引文
[1]李永库.重症监护病房脑外伤及脑血管病并发肺部感染163例致病菌及其耐药性、易感因素分析[J].苏州大学学报(医学版),2017,27(5):793-795.
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[6]王立,游丽莎.脑胸外科ICU内获得性感染的致病菌菌种及其药敏[J].热带医学杂志,2014,4(3):264-267.
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[11]王晶,崔朝勃,魏秋菊,等.重症医学科中心静脉导管相关性血行感染患者病原菌分布及耐药性分析[J].实用心脑肺血管病杂志,2015,23(5):84-86.
[12]蔡志萍,邢浪萍,史广玲,等.强化ICU护士导管相关性感染循证护理培训的效果[J].中华现代护理杂志,2015,17(4):446-449.
[13]牛辉妮,戴丹.针对性护理对ICU重型颅脑损伤患者感染发生的影响[J].国际护理学杂志,2014,34(6):1417-1419.
[14]朱志德,江永嘉,黄志伟,等.利奈唑胺治疗ICU革兰阳性球菌感染效果观察[J].中国基层医药,2017,24(4):542-546.
[15]王浩渊,陈晨,陈敏珊,等.重症医学科脑科术后患者获得性肺炎感染情况及病原学分析[J].国际医药卫生导报,2015,21(2):176-179.
[16]Nelson JE,Curtis JR,Mulkerin C,et al.Choosing and using screening criteria for palliative care consultation in the ICU:a report from the improving palliative care in the ICU(IPAL-ICU)advisory board[J].Crit Care Med,2013,41(10):2318-2327.
[2]Nakamura S,Iwanaga N,Seki M,et al.Toll-like receptor 4agonistic antibody promotes host defense against chronic Pseudomonas aeruginosa lung infection in mice[J].Infect Immun,2016,84(7):1986-1993.
[3]徐云峰,吴长江,黎宁君,等.ICU脑外伤合并肺部感染患者的致病高危因素分析及其处理措施探讨[J].医学信息,2016,29(21):267-267.
[4]王序,陈占伟,范红海,等.NICU脑出血气管切开患者肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(6):1336-1338.
[5]张令晖,于旭红,房宁宁,等.脑血管病合并肺部感染患者病原菌分布及耐药性分析[J].中国临床药理学杂志,2017,33(16):1549-1551.
[6]王立,游丽莎.脑胸外科ICU内获得性感染的致病菌菌种及其药敏[J].热带医学杂志,2014,4(3):264-267.
[7]尚红,王毓三,申子瑜.全国临床检验操作规程[M].北京:人民卫生出版社,2015:37-39.
[8]Latif A,Rawat N,Pustavoitau A,et al.National study on the distribution,causes,and consequences of voluntarily reported medication errors between the ICU and non-ICU settings[J].Crit Care Med,2015,41(2):389-398.
[9]张瑞敏,周海燕,谭颜华,等.ICU患者导管相关性感染的目标性监测分析[J].中华医院感染学杂志,2015,25(20):4694-4695,4727.
[10]Choi J,Hoffman LA,Schulz R,et al.Self-reported physical symptoms in intensive care unit(ICU)survivors:pilot exploration over four months post-ICU discharge[J].J Pain Symptom Manage,2014,47(2):257-270.
[11]王晶,崔朝勃,魏秋菊,等.重症医学科中心静脉导管相关性血行感染患者病原菌分布及耐药性分析[J].实用心脑肺血管病杂志,2015,23(5):84-86.
[12]蔡志萍,邢浪萍,史广玲,等.强化ICU护士导管相关性感染循证护理培训的效果[J].中华现代护理杂志,2015,17(4):446-449.
[13]牛辉妮,戴丹.针对性护理对ICU重型颅脑损伤患者感染发生的影响[J].国际护理学杂志,2014,34(6):1417-1419.
[14]朱志德,江永嘉,黄志伟,等.利奈唑胺治疗ICU革兰阳性球菌感染效果观察[J].中国基层医药,2017,24(4):542-546.
[15]王浩渊,陈晨,陈敏珊,等.重症医学科脑科术后患者获得性肺炎感染情况及病原学分析[J].国际医药卫生导报,2015,21(2):176-179.
[16]Nelson JE,Curtis JR,Mulkerin C,et al.Choosing and using screening criteria for palliative care consultation in the ICU:a report from the improving palliative care in the ICU(IPAL-ICU)advisory board[J].Crit Care Med,2013,41(10):2318-2327.