外科重症监护病房下呼吸道MRSA医院感染分析及护理对策

Analysis of lower respiratory tract MRSA nosocomial infection in surgical intensive care unit and nursing measures

目的分析外科重症监护病房（SICU）下呼吸道耐甲氧西林金黄色葡萄球菌（MRSA）医院感染及危险因素，并探讨防治措施。方法对2005年9月-2006年10月人住SICU11例下呼吸道MRSA医院感染病例进行回顾性分析。结果SICU下呼吸道MRSA医院感染率为1．40％，其特点是多为神经外科术后危重患者，入住SICU时间长，多接受气管插管、气管切开、鼻饲胃管等侵袭性操作及机械通气，均在感染前应用抑酸剂及抗菌药物，且以三代头孢及喹诺酮使用率高。药敏显示MRSA仅对万古霉素、替考拉宁高度敏感。结论SICU中下呼吸道MRSA医院感染率高，MRSA多重耐药严重。严重的原发疾病、侵袭性操作、机械通气及感染前应用抑酸剂及抗菌药物是下呼吸道MRSA医院感染的危险因素。应采取有效治疗护理措施以预防和控制SICU下呼吸道MRSA医院感染的发生和流行。

Objective To analyze the features and risk factors of lower respiratory tract MRSA nosocomial infection in surgical intensive care unit （SICU）, and to study its countermeasures. Methods Retrospective analysis on 11 cases with lower respiratory tract MRSA nosocomial infection from Sep 2005 to Oct 2006 were carried out. Results The rate of lower respiratory tract MRSA nosocomial infection in SICU was 1.40%, and the isolate rate of MRSA was 93.33%. Most of the eases were postoperative critical ill patients of neurosurgical and had long stay of SICU, and received mechanical ventilation and invasive operation, such as tract insertion, traeheotomy, nasal feeding gastric tub. Acid inhibitor and antibiotics were used for each patient before suffering lower respiratory tract MRSA nosocomial infection. The high frequency used antibiotics were the 3rd generation cephalosporin and quinolone. The drug sensitivity tests resuhs showed that MRSA was only sensitive to vancomycin and teieoplanin highly. Conclusions The rate of lower respiratory tract MRSA nosocomial infection and the isolate rate of MRSA are high in SICU. Severe primary disease, invasive operation, mechanical ventilation, long duration of the treatment with broad spectrum antibiotic and acid inhibitor are risk factors. Effective measures should be taken to prevent and control lower respiratory tract MRSA nosocomial infection in SICU.