ICU下呼吸道多重耐药菌感染的病原菌及易感因素分析

Analysis of the distribution of pathogens and predisposing factors for lower respiratory tract infections caused by multidrug resistant bacteria in intensive care unit

目的分析重症医学科(ICU)下呼吸道多重耐药菌感染的病原菌分布及易感因素。方法回顾性调查2011年1月至2012年3月ICU的下呼吸道感染患者78例,分析其多重耐药菌的分布情况及其易感因素。结果共检出致病菌98株,多重耐药菌77株,其中前三位致病菌为鲍曼不动杆菌(41.56%)、肺炎克雷伯杆菌(22.08%)、嗜麦芽寡养单胞菌(15.08%);多因素Logistic回归分析显示ICU住院时间、有创机械通气>48 h、多发伤、镇静药物使用为多重耐药菌感染的独立易感因素(P<0.05)。结论 ICU中下呼吸道多重耐药菌感染的病原菌以革兰阴性菌占优势,ICU住院时间、有创机械通气>48 h、多发伤、镇静药应用与患者多重耐药菌感染关系密切。

Objective To investigate the pathogens and predisposing factors of patients in ICU, who were infected by multidrug resistance bacterias （MDRB） in lower respiratory tract. Methods Retrospective survey of 78 cases infected in lower respiratory tract from January 2011 to March 2012 was performed, and the distribution and predisposing factors of MDRB were analyzed. Results A total of 98 pathogens were detected, 77 strains were multidrug resistant bacterial, the top three isolated pathogenic bacteria were acinetobacter baumannii/haemol （41.56%） , Klebsiella pneumoniae （22.08%） and pseudomonas aeruginosa （15.08%）. Multi - factor logistic analysis revealed that the length of stay in ICU, more than 48 hours of mechanical ventilation, multiple injuries and sedatives were independent predisposing factors for mulfidrug resistant bacterial infection （ P 〈 0.05 ）. Conclusion In pathogenic isolates from lower respiratory tract infection caused by MDRB, Gramnegative bacteria are predominant in number; the length of stay in ICU, days of invasive mechanical ventilation, polytrauma and sedatives are closely related with muhidrug- resistant bacterial infection.