RICU下呼吸道感染病原菌及多药耐药危险因素分析

Pathogens causing lower respiratory tract infections in ICU and risk factors of multi-drug resistance

目的通过观察呼吸重症监护病房(RICU)下呼吸道感染的病原菌分布及其耐药性,分析多药耐药的危险因素,以达合理治疗。方法收集2010年1月-2012年10月RICU 204例下呼吸道感染患者的痰液标本,常规微生物培养、鉴定,分析病原菌种类及耐药性;将多药耐药感染患者列入观察组,非多药耐药患者列入对照组,收集并比较两组患者的临床资料,分析其危险因素。结果 204例患者的痰液标本共分离出病原菌262株,革兰阴性杆菌138株占52.7%,以铜绿假单胞菌检出率最高为23.7%;革兰阳性球菌84株占32.0%,以金黄色葡萄球菌检出率最高为22.1%;真菌40株占15.3%,以白色假丝酵母菌为主占8.4%;多药耐药菌以铜绿假单胞菌、金黄色葡萄球菌、鲍氏不动杆菌为主;多药耐药菌的多因素logisitic回归分析显示,年龄>70岁、机械通气时间>2周、应用碳青霉烯类药物、有慢性阻塞性肺疾病(COPD)及糖尿病病史为多药耐药菌感染的独立危险因素(P<0.05)。结论引起RICU患者下呼吸道感染的因素为合并糖尿病、COPD、机械通气时间>2周及长期应用三代头孢或碳青霉烯类药物等,应检测其病原菌及耐药性,积极给予敏感抗菌药物治疗。

OBJECTIVE To investigate the distribution and drug resistance of the pathogenic bacteria causing the lower respiratory tract infections in the ICU so as to analyze the risk factors of multi-drug resistance and guide the reasonable treatment.METHODS The sputum specimens were collected from the patients with the lower respiratory tract infections who were treated in the ICU from Jan 2010 to Oct 2012.The routine bacterial culture and identification were performed,the species of the pathogens and the drug resistance were analyzed;the patients with the multidrug-resistant bacteria infections were assigned as the observation group,and the patients with the non-multidrug-resistant bacteria infections were set as the control group,the clinical data of the two groups of patients were collected and analyzed,and the risk factors were analyzed.RESULTS Totally 262 strains of pathogens were isolated from the sputum specimens of the 204 patients;there were 138（52.7%） strains of gram-negative bacilli,among which the detection rate of Pseudomonas aeruginosa was the highest（23.7%）;there were 84（32.0%） strains of gram-positive cocci,among which the detection rate of Staphylococcus aureus was the highest（22.1%）;there were 40（15.3%） strains of fungi,among which Candida albicans accounted for 8.4%;the muldirug-resistant P.aeruginosa,S.aureus,and A.baumannii were the predominant species;the multivariate logistic regression analysis indicated that the more than 70 years of age,mechanical ventilation duration more than 2 weeks,use of carbapenem antibiotics,COPD history,and diabetes history were the independent risk factors of the multidrug-resistant bacteria infections.CONCLUSION The complications of COPD or diabetes,mechanical ventilation duration more than 2 weeks,and long term use of third generation cephalosporins or carbapenem antibiotics are the risk factors associated with the lower respiratory tract infections in the ICU patients.It is necessary to detect the pathogens and drug resistance and use the susceptible antibiotics for the treatment.