心内科住院患者多药耐药铜绿假单胞菌医院感染危险因素分析

Investigation of cardiovascular inpatient infection risk factors of multi-drug resistant Pseudomonas aeruginosa

目的探讨多药耐药铜绿假单胞菌(MDRPA)的感染现状及医院内感染存在的危险因素。方法选取2006年至2011年在莱芜市人民医院心内科住院且分离出多药耐药铜绿假单胞菌的患者为研究对象,应用Mi-croscan Walk away 96SI全自动微生物鉴定仪检测以及测定药物敏感性,把多药耐药铜绿假单胞菌感染病例和同期检测出的敏感型铜绿假单胞菌比较,应用病例对照方法进行统计分析。应用单因素分析(t检验与χ2检验)和多因素Logistic回归方法进行统计分析。结果共选取心内科感染铜绿假单胞菌(PAE)160株,其中,多药耐药铜绿假单胞菌50株,总分离率为31.25%;标本大多取自呼吸道,占77.49%;应用单因素分析显示,既往曾在重症监护室治疗、存在基础疾病、住院天数、曾行纤维支气管镜灌洗治疗、应用机械通气的时间、分离出MDRPA前小于14 d给予碳青霉烯类抗生素和MDRP感染均有关联;进行多因素Logistic回归统计分析明确了3种独立的危险因素:既往曾在重症监护室治疗、进行过机械通气治疗、分离出MDRP前小于14 d曾给予碳青霉烯类抗生素治疗。结论既往曾经在重症监护室治疗、给予机械通气治疗和应用碳青霉烯类抗生素,以上为心内科住院患者感染多药耐药铜绿假单胞菌三种危险因素;加强无菌操作观念,掌握机械性通气的应用指征,改善病房条件是防范住院患者感染MDRPA的一项重要的方法。

Objective To investigate the cardiological inpatient infection status of multi - drug resistant Pseudomonas aeruginosa （MDRPA） analysis of hospital infection in the presence of risk factors for the control and prevention of inpa- tient with multi - drug resistant Pseudomonas aeruginosa bacterial infection provide a theoretical basis. Methods In cardiovascular patients of our hospital from 2006 to 2011 isolated multi - drug resistant Pseudomonas aeruginosa infection in hospital patients for the study, application Microscan Walk away 96SI automated microbial identification detected as well as determination of drug - sensitive sensitive Pseudomonas aeruginosa, check out the multi - drug resistant Pseudo- monas aeruginosa infections detected in the same period of comparison, the application of case - control methods for sta- tistical analysis, the application of single factor analysis （ t test and X2 test ） and multivariate logistic regression methods for statistical analysis. Results A total of selected department of cardiology infection Pseudomonas aeruginosa （PAE） 160 strain, including multi - drug resistant Pseudomonas aeruginosa 50, total interest rate of 31.25% ; Mostly from re- spiratory specimens, representing approximately 77.49%. Single factor analysis showed that previous treatment in the intensive care unit, the presence of underlying disease, length of stay, had undergone fiberoptic bronchoscopy lavage, mechanical ventilation time, isolated MDRPA less than 14 days before the given carbapenems antibiotics and MDRP in- fections are associated, logistic regression for multivariate statistical analysis to clear the three independent risk factors： previous treatment in the intensive care unit and treated with mechanical ventilation isolated the MDRP had given less than 14 days before the carbon green mildew alkenes antibiotic treatment. Conclusions The past once treated in the in- tensive care unit and treated with mechanical ventilation and the application of carbapenem antibiotics, more than three risk factors for muhidrug - resistant Pseudomonas aeruginosa infection in cardiological hospitalized patients, strengthen the concept of aseptic, master the mechanical ventilation indications, improve the ward conditions are important methods for prevention the inpatients infected MDRPA.