ICU气管切开患者呼吸道感染影响因素分析
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摘要
目的探讨重症监护室(ICU)气管切开患者呼吸道感染影响因素,为呼吸道感染的防治提供参考。方法选取2017年1月-12月在医院ICU行气管切开术的84例患者,在气管切开后的第3、7、10、14天分别采集患者咽部及下呼吸道分泌物,行细菌培养及观察是否发生呼吸道感染,分析结果。整理分析患者临床资料,分析呼吸道感染率的影响因素。结果 84例行气管切开术的患者,56例患者发生呼吸道感染,感染率为66.67%;共检出病原菌67株,其中革兰阴性菌43株占64.18%,革兰阳性菌24株占35.72%,主要感染病原菌为肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌,分别占23.88%、20.90%、17.91%;非条件多因素Logistic回归分析显示,年龄≥60岁、合并糖尿病、使用糖皮质激素、使用呼吸机、气管切开时间≥7d、GCS评分<8分是ICU气管切开患者呼吸道感染的影响因素(P<0.05)。结论 ICU气管切开患者容易发生呼吸道感染,呼吸道感染是多种因素共同作用的结果,应针对影响因素进行干预,以降低呼吸道感染的发生。
OBJECTIVE To explore the risk factors of respiratory tract infection in tracheotomy patients in intensive care unit(ICU),so as to provide reference for prevention and control of respiratory tract infection.METHODS We selected 84 cases of tracheotomy patients in ICU during Jan.to Dec.2017.The pharynx and lower respiratory secretions of the tracheotomy patients were collected on day 3,7,10 and 14 after tracheotomy,for which bacterial culture was performed and the occurrence of respiratory tract infection was observed.The results were analyzed.The clinical data of the patients were collected and the influencing factors of the respiratory tract infection rate were analyzed.RESULTS Among the 84 tracheotomy patients,56 cases of respiratory tract infection occurred,and the infection rate was 66.67%.A total of 67 strains of pathogens were isolated,of which 43 were gram-negative bacteria(64.18%)and 24 were gram-positive bacteria(35.72%).The main pathogenic bacteria were Klebsiella pneumoniae,Staphylococcus aureus and Pseudomonas aeruginosa,accounting for 23.88%,20.90% and 17.91%respectively.Non-conditional multivariate logistic regression analysis showed that age of≥60 years old,diabetes,use of glucocorticoid,use of ventilator,tracheotomy time of≥7 dand GCS score of<8 were independent risk factors of respiratory tract infection in tracheotomy patients in ICU(P<0.05).CONCLUSION The incidence of respiratory tract infection is high in tracheotomy patients in ICU,and the infection is the result of many factors.Intervention should be given according to the corresponding influencing factors,in order to reduce the incidence of respiratory infections.
OBJECTIVE To explore the risk factors of respiratory tract infection in tracheotomy patients in intensive care unit(ICU),so as to provide reference for prevention and control of respiratory tract infection.METHODS We selected 84 cases of tracheotomy patients in ICU during Jan.to Dec.2017.The pharynx and lower respiratory secretions of the tracheotomy patients were collected on day 3,7,10 and 14 after tracheotomy,for which bacterial culture was performed and the occurrence of respiratory tract infection was observed.The results were analyzed.The clinical data of the patients were collected and the influencing factors of the respiratory tract infection rate were analyzed.RESULTS Among the 84 tracheotomy patients,56 cases of respiratory tract infection occurred,and the infection rate was 66.67%.A total of 67 strains of pathogens were isolated,of which 43 were gram-negative bacteria(64.18%)and 24 were gram-positive bacteria(35.72%).The main pathogenic bacteria were Klebsiella pneumoniae,Staphylococcus aureus and Pseudomonas aeruginosa,accounting for 23.88%,20.90% and 17.91%respectively.Non-conditional multivariate logistic regression analysis showed that age of≥60 years old,diabetes,use of glucocorticoid,use of ventilator,tracheotomy time of≥7 dand GCS score of<8 were independent risk factors of respiratory tract infection in tracheotomy patients in ICU(P<0.05).CONCLUSION The incidence of respiratory tract infection is high in tracheotomy patients in ICU,and the infection is the result of many factors.Intervention should be given according to the corresponding influencing factors,in order to reduce the incidence of respiratory infections.
引文
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[13]郭大志,沈晨,张禹,等.气管切开与非气管切开患者肺部感染病原菌分布及耐药率比较分析[J].检验医学与临床,2016,13(19):2743-2745.
[14]宋丽萍,林艳华,周妍君,等.神经外科气管切开患者肺部感染的相关危险因素及护理对策分析[J].齐齐哈尔医学院学报,2017,38(17):2070-2071.
[15]符春花,周保娇,李珍美,等.ICU气管切开患者肺部感染危险因素与护理干预[J].中国消毒学杂志,2017,34(8):760-763.
[16]汤颖,胡阳琼,肖灿,等.神经外科气管切开患者多重耐药菌感染的危险因素分析[J].实用医院临床杂志,2017,14(4):81-84.
[17]Ekren PK,Ranzani OT,Ceccato A,et al.Evaluation of the2016Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilatorassociated Pneumonia in the ICU[J].Am J Respir Crit Care Med,2018,197(6):826-830.
[18]Bassi GL,Ferrer M,Marti JD,et al.Ventilator-associated pneumonia[C].Semin Respir Crit Care Med,2014,35(04):469-481.
[19]El-Rabbany M,Zaghlol N,Bhandari M,et al.Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia:a systematic review[J].Int JNurs Stud,2015,52(1):452-464.
[2]Dasgupta S,Das S,Chawan NS,et al.Nosocomial infections in the intensive care unit:Incidence,risk factors,outcome and associated pathogens in a public tertiary teaching hospital of Eastern India[J].Indian J Crit Care Med,2015,19(1):14-20.
[3]Chacko B,Thomas K,David T,et al.Attributable cost of a nosocomial infection in the intensive care unit:aprospective cohort study[J].World J Crit Care Med,2017,6(1):79-84.
[4]Maechler F,Pena Diaz LA,Schroder C,et al.Prevalence of carbapenem-resistant organisms and other gram-negative MDRO in German ICUs:first results from the national nosocomial infection surveillance system(KISS)[J].Infection,2015,43(2):163-168.
[5]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[6]田露萍,潘金波,戚国青,等.ICU气管切开患者下呼吸道感染病原菌与相关因素分析[J].中华医院感染学杂志,2016,26(16):3716-3718.
[7]Russell CJ,Mack WJ,Schrager SM,et al.Care variations,length of stay and readmission in children hospitalized for bacterial tracheostomy-associated respiratory infections[J].Hosp Pediatr,2017,7(1):16-23.
[8]Sole ML,Talbert S,Penoyer DA,et al.Comparison of respiratory infections before and after percutaneous tracheostomy[J].Am J Crit Care,2014,23(6):e80-e87.
[9]李迎春,董英.气管切开术后患者肺部感染的危险因素及护理措施[J].中华实验和临床感染病杂志(电子版),2013,7(4):89-91.
[10]Gadsby NJ,McHugh MP,Russell CD,et al.Development of two real-time multiplex PCR assays for the detection and quantification of eight key bacterial pathogens in lower respiratory tract infections[J].Clin Microbiol Infect,2015,21(8):788.e1-788.e13.
[11]Kronman MP,Zhou C,Mangione-Smith R.Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections[J].Pediatrics,2014,134(4):e956-e965.
[12]郑叶平,沈杰,徐少毅,等.ICU气管切开患者下呼吸道感染病原学特点及恒温湿化系统的预防效果分析[J].中华医院感染学杂志,2017,27(19):4393-4396.
[13]郭大志,沈晨,张禹,等.气管切开与非气管切开患者肺部感染病原菌分布及耐药率比较分析[J].检验医学与临床,2016,13(19):2743-2745.
[14]宋丽萍,林艳华,周妍君,等.神经外科气管切开患者肺部感染的相关危险因素及护理对策分析[J].齐齐哈尔医学院学报,2017,38(17):2070-2071.
[15]符春花,周保娇,李珍美,等.ICU气管切开患者肺部感染危险因素与护理干预[J].中国消毒学杂志,2017,34(8):760-763.
[16]汤颖,胡阳琼,肖灿,等.神经外科气管切开患者多重耐药菌感染的危险因素分析[J].实用医院临床杂志,2017,14(4):81-84.
[17]Ekren PK,Ranzani OT,Ceccato A,et al.Evaluation of the2016Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilatorassociated Pneumonia in the ICU[J].Am J Respir Crit Care Med,2018,197(6):826-830.
[18]Bassi GL,Ferrer M,Marti JD,et al.Ventilator-associated pneumonia[C].Semin Respir Crit Care Med,2014,35(04):469-481.
[19]El-Rabbany M,Zaghlol N,Bhandari M,et al.Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia:a systematic review[J].Int JNurs Stud,2015,52(1):452-464.