耐甲氧西林金黄色葡萄球菌感染与定植危险因素分析

Risk factors for methicillin-resistant Staphylococcus aureus infections and colonization

目的通过对耐甲氧西林金黄色葡萄球菌(MRSA)感染与定植病例的调查,探讨医院MRSA感染与定植的危险因素及防治策略。方法选取MRSA感染与定植病例80例患者临床资料,采用流行病学研究方法,根据综述、专家咨询以及实际工作经验,最终确定变量进行危险因素分析;通过EPIDATA3.02软件进行数据录入;使用SPSS16.0软件对数据进行统计分析,应用χ2检验对定性资料进行单因素分析,应用非条件logistic回归分析进行多因素分析。结果纳入单因素分析的变量共12个,经过统计分析,筛选出8个变量进入多因素logistic回归模型;调整了年龄、性别、基础疾病的影响后,抗菌药物使用时间≥14d、抗菌药物使用种类≥3种、住院天数≥30d是独立的危险因素;抗菌药物使用≥14d与<14d的感染或定植率分别为89.3%和28.8%、抗菌药物使用种类≥3种与<3种的感染或定植率分别91.3%和33.3%、住院天数≥30d与<30d的感染或定植率分别为50.8%和47.6%;3种危险因素的OR值(95%CI)分别为28.887(19.103～33.237)、21.194(18.156～29.993)、18.142(13.782～27.104)。结论抗菌药物长期使用、联合使用、长期住院是MRSA感染与定植的危险因素,应根据患者病情特点,积极采取预防控制措施,防止耐药菌的产生和传播。

OBJECTIVE To investigate the cases of methicillin-resistant Staphylococcus aureus（MRSA）infections and colonization and explore the risk factors for the MRSA infections and colonization so as to put forward the prevention strategies.METHODS The clinical data of 80cases of MRSA infections and colonization were collected;by means of epidemiological survey,the variables and risk factors were determined according to the review,consultant to experts,and working experience,the data were input through EPIDATA3.02software,the statistical analysis was performed with the use of SPSS16.0software,the chi-square test was conducted for the analysis of qualitative data,and the non-conditional multivariate logistic regression analysis was performed.RESULTS Totally 12 variables were included in the univariate analysis,and 8were screened out through the statistical analysis and brought into the multivariate logistic regression model.The adjusted age,gender,underlying disease,duration of drug therapy more than 14days,use of antibiotics more than three types,and hospitalization duration more than 30days were the independent risk factors.The incidence rate of bacterial infections or colonization was 89.3% in the patients with the use of antibiotics more than 14days,28.8% in the patients with the use of antibiotics less than 14days,91.3% in the patients with the use of antibiotics more than 3types,33.3% in the patients with the use of antibiotics less than three types,50.8% in the patients with the hospitalization duration more than 30days, 47.6% in the patients with the hospitalization duration less than 30days;the OR values of the three risk factors were 28.887（95%CI19.103-33.237）,21.194（95%CI18.156-29.993）,and 18.142（95%CI 13.782-27.104）, respectively.CONCLUSIONLong-term use of antimicrobial drugs,combination use of antibiotics,and long-term hospital stay are the risk factors for the bacterial infection or colonization,and it is necessary to take effective prevention and control measures according to the patients′condition so as to prevent the emergence and spread of drug resistant strains.