重症医学科鲍曼不动杆菌医院感染危险因素分析

NOSOCOMIAL INFECTION CAUSED BY ACINETOBACTER BAUMANNII IN INTENSIVE CARE UNIT

目的探讨重症医学科(ICU)鲍曼不动杆菌医院感染危险因素,为制定医院感染防治策略提供依据。方法用回顾性病例对照研究和非条件Logistic多元回归分析方法,对2004年8月—2011年7月ICU 1 950例病人鲍曼不动杆菌医院感染的危险因素进行分析。结果单因素分析结果显示,应用糖皮质激素(OR=3.364,95%CI1.445～7.830)、昏迷或颅脑损伤(OR=4.026,95%CI1.545～10.490)、腹部手术(OR=0.166,95%CI0.068～0.403)、有胸腹引流管(OR=0.350,95%CI0.150～0.818)、开放气道(OR=4.095,95%CI1.638～10.740)为鲍曼不动杆菌医院感染的危险因素。多因素Logistic分析结果显示,应用糖皮质激素(OR=3.143,95%CI1.115～8.856)、机械通气(OR=3.195,95%CI1.607～6.353)为鲍曼不动杆菌医院感染独立危险因素。结论应用糖皮质激素和机械通气是鲍曼不动杆菌医院感染独立危险因素,应针对危险因素采取措施进行控制。

Objective To investigate the risk factors of nosocomiai infection caused by A. Baumannii in intensive care unit （ ICLI）, and provide a reference for its prevention. Methods Using retrospective case-control study and multivariable logistic re- gression analysis, risk factors of 1 950 patients with A. Baumannii infection in ICU, from August 2004 to July 2011, were ~na- lyzed. Results Univariate analysis showed the use of hormone （OR= 3. 364,95% CI 1. 445- 7. 830）, unconsciousness or cranioeerebral trauma （0R=4. 026,95%CI 1. 545-10. 490）, abdominal surgery （OR=0. 166,95%CI 0. 068-0. 403）, chest or abdominal drainage tube （OR=0.350,95%CI 0.150-0.818）, and open airway （0R=4.095,95%CI 1. 638-10. 740） were the risk {actors responsible for nosocomial infectlon caused by A. Baumannii. Multivariate analysis indicated that the use of hormone （OR=3. 143,95%CI 1. 115-8. 856）, mechanical ventilation （OR=3. 195,95%CI 1. 607-6. 353） were the independent risk factors of the infection. Conclusion The independent risk factors of nosocomial infection caused by A. Baumannii in ICU are the use of corticosteroid and mechanical ventilation. Measures aiming at the risk factors should be taken to control this kind of infection.