住院患者多药耐药铜绿假单胞菌医院感染危险因素的探讨

摘要

目的 探讨神经内科住院患者多药耐药铜绿假单胞菌(MDRPA)感染现状及医院内感染的危险因素.方法 选取2006年至2011 年在神经内科住院且分离出多药耐药铜绿假单胞菌的患者为研究对象,应用Microscan Walk away 96SI 全自动微生物鉴定仪检测药物敏感性,应用病例对照方法把多药耐药铜绿假单胞菌感染病例和同期检测出的敏感型铜绿假单胞菌作比较,.应用单因素分析(t 检验与χ2检验)和多因素Logistic 回归方法进行统计分析.结果 共选取神经内科感染铜绿假单胞菌(PAE)60 株,其中,多药耐药铜绿假单胞菌20 株,总分离率为33.33%;标本大多取自呼吸道,约占77.49%;应用单因素分析显示,既往曾在重症监护室治疗、存在基础疾病、住院天数、曾行纤维支气管镜灌洗治疗、应用机械通气的时间、分离出MDRPA 前小于14 d 给予碳青霉烯类抗生素和MDRP 感染均有关联;进行多因素Logistic 回归统计分析明确了3 种独立的危险因素:既往曾在重症监护室治疗、进行过机械通气治疗、分离出MDRP 前小于14 d 曾给予碳青霉烯类抗生素治疗.结论 既往曾经在重症监护室治疗、给予机械通气治疗和应用碳青霉烯类抗生素为神经内科住院患者感染多药耐药铜绿假单胞菌3 种危险因素;加强无菌操作观念,掌握机械性通气的应用指征,改善病房条件是防范住院患者感染MDRPA 的一项重要方法.%Objective To investigate the infection status and the presence of risk factors of nosocomial infection in hospitalized patients with multi-drug resistant pseudomonas aeruginosa (MDRPA) admitted to the department of neurology in our hospital. Methods Patients with multidrug-resistant pseudomonas aeruginosa isolated, who were hospitalized in this hospital from 2006 to 2011, were selected as the research object. Microscan Walk away 96SI automated microbial identification apparatus was applied in the determination of drug sensitivity; case-control method was used to compare multidrug-resistant pseudomonas aeruginosa infection cases with sensitive pseudomonas aeruginosa detected in the same period for statistical analysis: single factor analysis (t test and X2 test) was applied and the method of multivariate logistic regression was utilized for statistical analysis. Results A total of 60 strains were selected in patients infected with pseudomonas aeruginosa (PAE), in which there were 20 strains of multidrug resistant pseudomonas aeruginosa, and the total separation rate was 33.33%; the specimens were mostly from respiratory tracts, accounting for 77.49%; univariate analysis showed such factors like the previous treatment in the intensive care unit, the presence of underlying diseases, length of stay, experience of fiberoptic bronchoscopy lavage, mechanical ventilation time, treatment with car-bapenems antibiotics less than 14 d before MDRPA isolation, and MDRP infections were associated; statistical analysis of multivariate logistic regression clarified the three independent risk factors: previous treatment in the intensive care unit, previous treatment with mechanical ventilation, and application of carbapenems antibiotics less than 14 d before MDRPA isolation. Conclusion The previous treatment in the intensive care unit, with mechanical ventilation and the application of carbon carbapenem antibiotics are three risk factors for inpatients in the department of neurology infected with MDRPA; the prevention of hospitalized patients from infection of MDRPA lies in strengthening the concept of aseptic operation, grasping the indications for mechanical ventilation, and improving the ward conditions.