院内下呼吸道非发酵菌感染的调查及多重耐药非发酵菌下呼吸道感染危险因素分析

Nosocomial Non-fermented Bacterial Infection in Lower Respiratory Tract and Risk Factors for Multi-drug Resistant Bacterial Infection

目的了解院内下呼吸道非发酵菌感染的特点，以及院内多重耐药非发酵菌下呼吸道感染的危险因素。方法对湘雅医院2007年1月～12月院内下呼吸道非发酵菌感染病例229例进行回顾性分析，记录致病菌分布和药物敏感性。其中多重耐药菌感染183例，进行多因素Logistic回归分析院内多重耐药非发酵菌下呼吸道感染的危险因素。结果菌株分离率排前四位的分别是铜绿假单胞菌（47．6％）、鲍曼不动杆菌（36．3％）、不动杆菌属某种（8．6％）及嗜麦芽窄食单胞菌（5．1％）；神经外科（25．7％）和中心ICU（22．9％）分离率较高。非发酵菌（嗜麦芽窄食单胞菌除外）除对头孢哌酮／舒巴坦、美洛培南保持较好敏感性外，对其他抗生素均严重耐药。入住ICU（OR=23．77，P〈0．001）、气管切开或插管（OR=4．16，P=0．001）、前期碳青霉烯类抗生素的使用（OR=2．77，P=0．032）是独立的院内多重耐药非发酵菌下呼吸道感染危险因素。结论非发酵菌为院内下呼吸道感染的重要致病菌，大部分耐药严重。严格把握入住ICU、气管切开及碳青霉烯类抗生素使用指征对防止多重耐药非发酵菌感染极为重要。

Objective To investigate nosocomial non-fermented bacterial infection in lower respiratory tract and the risk factors for muhi-drug resistant bacterial infection. Methods 229 patients with nosocomial non- fermented bacterial infection in lower respiratory tract from January to December in 2007 in Xiangya Hospital were analyzed retrospectively. The distribution and drug sensitivity of pathogens were recorded. Of those 229 patients, 183 cases were infected by non-fermented nmlti-drug resistant bacteria（MDRB）. The risk factors for non-fermented MDRB infection in lower respiratory tract were analyzed by multi-factor logistic multiple regression analysis. Results The top four non-fermented bacteria isolated were Pseudomonas aeruginosa （47.6%）, Acinetobacter baumannii（ 36. 3 % ） ,Acinetobacter spp（ 8. 6% ）, and Stenotrophomonas maltophilia （5. 1% ）. Higher isolatated rate was found in neurosurgery （ 25.7% ） and central ICU （ 22.9% ）. The isolated non-fermented bacteria except Stenotrophomonas mahophilia were resistant to all antibiotics except cefoperazone-sulbaetam and meropenem. ICU stay （P 〈 0. 001 ） , tracheotomy or tracheal intubation （P = 0. 001 ） , and previous use of carbapenem antibiotics （P = 0.032） were independent risk factors for non-fermented MDRB infection. Conclusion Non-fermented bacillus were important pathogens of nosocomial infection in lower respiratory tract with high rates of antibiotic resistance. It is important to prevent non-fermented MDRB infection by strict limitation on the indication of ICU stay, tracheotomy and use of carbapenem.