下呼吸道多重耐药菌感染的危险因素分析

Risk factors for lower respiratory tract infections caused by multidrug resistant bacteria

目的探讨下呼吸道多重耐药菌感染的危险因素,为制定和采取预防控制措施提供科学依据。方法纳入符合下呼吸道感染诊断且两次以上痰培养细菌呈阳性并为同一菌株的208例住院患者,分为多重耐药菌(MDRB)感染组(112例)和非MDRB感染组(96例),调查其临床资料:包括一般资料、基础疾病、痰培养的病原菌及药敏结果、侵袭性治疗措施、院内应用抗菌药物及糖皮质激素的情况等18项相关因素。以单因素分析筛选出有统计学意义的相关危险因素,再通过多因素logistic回归分析方法确定与MDRB感染关系密切的危险因素。结果与MDRB感染关系密切的危险因素分别为吸烟史(OR:1.182,95%CI:1.193-2.779)、痰培养细菌呈阳性前的住院天数(OR:1.131,95%CI:1.009-1.268)、留置胃管(OR:6.537,95%CI:2.913-14.667)、机械通气(OR:2.818,95%CI:1.079-7.358)、院内应用抗菌药物(OR:1.056,95%CI:0.549-2.030)。结论下呼吸道多重耐药菌感染是患者自身的内环境、侵袭性治疗措施和医院环境多种因素综合作用的结果,吸烟史、痰培养细菌呈阳性前的住院天数、留置胃管、机械通气和院内应用抗菌药物与MDRB感染关系密切,可能是其独立危险因素。

Objective To investigate the risk factors for lower respiratory tract infections caused by multidrug resistant bacteria and provide evidence for prevention and controlling measure of MDRB infections. Methods 208 patients with lower respiratory tract infections and positive results （t〉2） in bacteria culture in sputum for the same strains were divided into MDRB infections group（ 112 cases）and the non-MDRB infections group（96 cases）. 18 related factors were investiga- ted. Several statistically significant risk factors were screened out with single factor analysis, thereaft- er independent risk factors of MDRB infections were determined with multivariate logistic regression analysis. Results In the muhivariable logistic analysis results of MDRB infections＇ related factors, smoking history（ OR：I. 821,95% CI：1. 193-2. 779）, the days in hospital before positive results in bacteria culture in sputum （ OR ： 1.131,95 % CI ： 1. 009-1. 268 ）, indwellin gstric tube （ OR ： 6. 537, 95 % CI ： 2. 913-14. 667 ） , mechanical ventilation （ OR ：2.818,95 % CI ： 1. 079-7. 358 ） and use of antimicrobial drugs（ OR： 1. 056, 95% C1：0. 549-2. 030） were significantly associated with MDRB infections. Conclusions Various factors included the patient condition, invasive treatment meas- ures and the hospital environment contributed to lower respiratory tract infections caused by multi- drug resistant bacteria infections. Smoking history, the days in hospital before positive results in bacteria culture in sputum, indwellining gstric tube, mechanical ventilation and use of antimicrobial drugs were significantly related to MDRB infections, they may be the independent risk factors of MDRB infections.