RICU产超广谱β-内酰胺酶(ESBLs)菌感染危险因素分析

The analysis of risk factors of infection about RICU ESBLs-producing bacteria

目的调查呼吸重症监护病房(RICU)下呼吸道感染(LRI)患者产超广谱β-内酰胺酶(ESBLs)菌危险因素。方法通过病例对照研究和回顾性研究分析2000年1月1日～2006年12月31日间我院呼吸内科、ICU及RICU感染产超广谱β-内酰胺酶(ESBLs)菌及未感染产超广谱β-内酰胺酶(ESBLs)菌患者病案资料,作回归分析。结果2001～2006年间我院RICU产ESBLs菌阳性率有逐年上升趋势。Logistic回归分析显示,反复肺部感染、侵入性操作及住院时间≥14天为RICU产ESBLs菌高危因险,统计结果有显著性差异。结论RICU多为重症呼吸道感染患者或反复感染且初始治疗失败的患者,为产ESBLs菌高发区。其产ESBLs菌阳性率高于呼吸内科及普通ICU。反复呼吸道感染、侵入性操作、年龄≥60岁、反复而长时间的住院为其高危因素。

Objective To investigate the risk factors of ESBLs-producing bacteria from lower respiratory tract infection （LRI） at respiratory intensive care unit. Methods The medical record data of LRI patients with or without ESBLs-producing bacteria, which were obtained respiratory department, ICU and RICU from January 2000 to December 2006, were analyzed in the case-control study retrospectively. Chi-square test and unconditional logistic regression were used to analyze the data. Results From January 2000 to December 2006 in our hospital, the positive isolating rate of ESBLs-producing bacteria was higher in RICU than that in ICU and respiratory department, and was up year by year. The unconditional logistic regression analysis showed that repeated infections of respiratory tract infection, invasire operations and hospital-stay more than 14 days were the most important risk factors for positive isolating rate of ESBLs-producing bacteria in RICU, and the statistical results had significant differences. Conclusion Because much more patients with serious LRI or repeated respiratory tract infection stayed in RICU, the positive isolating rate of ESBLs-producing bacteria was higher in RICU than that in the resplratory department or ICU. Repeated respiratory tract infection, invasive operations, age more than 60 years old and repeated or long time hospitalization are the most important risk factors for positive isolating rate of ESBLs-producing bacteria in RICU.