热带病与寄生虫学

热带病与寄生虫学 ›› 2015, Vol. 13 ›› Issue (4): 215-218.doi: 10.3969/j.issn.1672-2302.2015.04.009

• 论著 • 上一篇    下一篇

呼吸重症监护病房下呼吸道感染病原菌种类、耐药状况及多重耐药菌感染危险因素分析

刘玲，赵弘卿*，王昕华，许坤，王洵   

  1. 214002  江苏无锡市，南京医科大学附属无锡市第二人民医院呼吸内科
  • 出版日期:2015-12-10 发布日期:2016-01-05

Pathogen type, antimicrobial resistance and risk factors for multidrug-resistant pathogens in patients with lower respiratory tract infections managed in the respiratory intensive care unit

Liu Ling, Zhao Hongqing*, Wang Xinhua, Xu Kun, Wang Xun   

  1. Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
  • Online:2015-12-10 Published:2016-01-05

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1859

被引次数

5

摘要： 目的  调查呼吸重症监护病房（RICU）下呼吸道感染病原菌种类及耐药情况，探索引发多重耐药菌感染的危险因素，为制订预防和控制多重耐药菌感染措施提供参考依据。 方法  收集2014年1~12月在无锡市第二人民医院RICU接受治疗的74例痰培养阳性下呼吸道感染病例作为研究对象，对引发下呼吸道感染的病原菌种类及其耐药情况进行调查，统计分析可能导致多重耐药菌感染的危险因素。 结果  74例研究对象中分离出161株病原菌，占前4位的病原菌分别为金黄色葡萄球菌（23.60%）、肺炎克雷伯杆菌（20.50%）、鲍曼不动杆菌（16.15%）和铜绿假单胞菌（9.94%）。其中多重耐药菌106株（65.84%），主要包括金黄色葡萄球菌（35.85%）、肺炎克雷伯杆菌（22.64%）、鲍曼不动杆菌（14.15%）等；泛耐药菌12株（7.45%），主要为鲍曼不动杆菌（11株）和肺炎克雷伯杆菌（1株）。74例病例中有49例（66.22%）感染2种以上病原菌，其中合并耐甲氧西林金黄色葡萄球菌（MRSA）感染31例（41.89%）。Logistics回归分析显示，急性生理与慢性健康评分（APACHEⅡ）为多重耐药菌感染的独立危险因素。 结论  RICU下呼吸道多重耐药菌感染发生率高，APACHEⅡ评分是多重耐药菌感染的独立危险因素。

关键词: 呼吸重症监护病房, 下呼吸道感染, 多重耐药, 危险因素

Abstract:

Objective  To investigate the distribution of pathogens and antimicrobial resistance among patients with lower respiratory tract infections managed in respiratory intensive care unit(RICU), and analyze the risk factors for multi-drug resistant pathogen infections for evidences to control and prevent the drug resistance. Methods  A total of 74 patients with lower respiratory tract infections and positive sputum cultures, undergone treatment in the RICU in Wuxi No. 2 People’s Hospital from January to December of 2014, were enrolled in the study. The distribution of pathogens inducing lower respiratory tract infections and antimicrobial resistance were investigated, and the risk factors for multi-drug resistant bacterial infections were identified and statistically analyzed. Results  A total of 161 pathogens were isolated from the 74 subjects, and the top 4 pathogens included Staphylococcus aureus (23.60%), Klebsiella pneumoniae (20.50%), Acinetobacter baumannii (16.15%) and Pseudomonas aeruginosa (9.94%). 106 strains of multi-drug resistant pathogens (65.84%) were identified, in which S. aureus (35.85%), K. pneumoniae (22.64%) and A.baumannii (14.15%) were prominent. Twelve strains of pan-drug resistant pathogens (7.45%)were associated with A. baumannii (11 strains) and K. pneumoniae (1 strain). Forty-nine of 74 patients (66.22%) were co-infected with at least two types of pathogens, in whom 31 patients (41.89%) were co-infected with methicillin-resistant S. aureus. Logistic regression analysis indicated that Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) scoring was independent risk factor of multi-drug resistant bacterial infections. Conclusion  Higher multi-drug resistant bacterial infections were observed in the patients with lower respiratory tract infections managed in RICU, and APACHE Ⅱ is an independent risk factor of multi-drug resistant bacterial infections.

Key words: Respiratory intensive care unit, Lower respiratory tract infection, Multi-drug resistance, Risk factor