ICU患者发生耐碳青霉烯类阴沟肠杆菌医院获得性肺炎的危险因素

摘要

Objective To explore risk factors for healthcare-associated pneumonia (HAP) caused by carbapenemresistant Enterobacter cloacae (CREC) in patients in intensive care unit (ICU).Methods From July 2013 to June 2017, 64 patients with CREC-HAP in ICU of a hospital were collected as case group, and 64 patients with carbapenem-sensitive Enterobacter cloacae HAP (CSEC-HAP) were as control group, risk factors for the occurrence of CREC-HAP were analyzed retrospectively by 1∶1 matched case-control study.Results Univariate analysis showed that APACHE II score≥20, long length of ICU stay, use of ventilator, long length of ventilator use, use of carbapenems, long duration of antimicrobial use, and at least 2 kinds of antimicrobial agents combined use were associated with the occurrence of CREC-HAP (all P＜0.05).Multivariate logistic regression analysis showed that APACHE II score≥20, use of ventilator, long length of ventilator use, use of carbapenems, and long duration of antimicrobial use were independent risk factors for occurrence of CREC-HAP (all P＜0.05).Conclusion Risk factors for occurrence of CREC-HAP in ICU patients include the use of carbapenems, long length of ventilator use, long duration of antimicrobial use, and APACHE II score≥20.Effective preventive and control measures can be formulated and taken in view of the above risk factors.%目的 探讨重症监护病房(ICU)患者发生耐碳青霉烯类阴沟肠杆菌医院获得性肺炎的危险因素.方法 收集某院2013年7月—2017年6月ICU内耐碳青霉烯类阴沟肠杆菌医院获得性肺炎患者64例作为病例组,对碳青霉烯类抗生素敏感的阴沟肠杆菌医院获得性肺炎患者64例作为对照组,采用1∶1配对进行回顾性病例对照研究分析其发生的危险因素.结果 单因素分析显示,APACHE II评分≥20、ICU住院日数长、使用呼吸机、使用呼吸机日数长、使用碳青霉烯类抗生素、抗菌药物使用日数长、抗菌药物应用≥2联与耐碳青霉烯类阴沟肠杆菌医院获得性肺炎的发生有关(均P＜0.05).多因素logistic回归分析显示,APACHE II评分≥20、使用呼吸机、使用呼吸机日数长、使用碳青霉烯类、抗菌药物使用日数长是发生耐碳青霉烯类阴沟肠杆菌医院获得性肺炎的独立危险因素(均P＜0.05).结论 导致ICU患者发生耐碳青霉烯类阴沟肠杆菌医院获得性肺炎的危险因素包括使用碳青霉烯类抗生素、使用呼吸机日数长、抗菌药物使用日数长、APACHE II评分≥20.可针对上述危险因素,制定并采取有效防控措施.