泛耐药鲍氏不动杆菌医院感染危险因素的研究

Study on risk factors of nosocomial infection caused by pan-drug resistant Acinetobacter baumannii

目的研究泛耐药鲍氏不动杆菌(PDRAB)医院感染的危险因素,为有效预防和控制PDRAB医院感染提供参考资料。方法采用病例对照研究方法,对PDRAB感染的相关因素进行分析,确定危险因素。结果 61例PDRAB医院感染患者,感染多发生于入院后1～3周,感染类型以肺部感染为主,占70.5%,其次为创面及血液感染,分别占16.4%、6.6%;单因素分析显示,PDRAB医院感染的危险因素有气管切开(OR=31.0)、呼吸机通气(OR=31.0)、气管插管(OR=16.5)、入住ICU(OR=11.3)、其他插管(OR=2.3)及输氧(OR=2.1);多因素非条件logistic回归分析,进一步得出PDRAB医院感染的独立危险因素为气管切开和呼吸机通气。结论加强重症监护病房的消毒、隔离制度,减少或规避侵入性诊疗操作,是有效预防和控制PDRAB医院感染的关键。

OBJECTIVE To study the risk factors of nosocomial infection caused by pan-drug resistant Acinetobacter baumannii（PDRAB）. METHODS A case-control study was carried out to identify the risk factors such as the performance of mechanical ventilation,hospitalization in ICU,previous antimicrobial therapy,and the presence of tracheal,central venous or urinary catheters. RESULTS Among sixty-one patients of PDRAB nosocomial infection,most of them infected PDRAB after admission one to three weeks.The main type of infection was lung infection（70.5%）,then the raw surface infection（16.4%）and blood infection（6.6%）.The risk factors of nosocomial infection caused by PDRAB were incision of trachea（OR=31.0）,the performance of mechanical ventilation（OR=31.0）,tracheal intubation（OR=16.5）,hospitalization in ICU（OR=11.3）,the presence of central venous or urinary catheters（OR=2.3）and oxygen transfer（OR=2.1）.The independent risk factors of nosocomial infection caused by PDRAB were incision of trachea and the performance of mechanical ventilation. CONCLUSIONS It′s critical to strengthen disinfection and isolation in intensive care units and to decrease the invasive procedures so as to prevent and control nosocomial infection caused by PDRAB.