糖尿病患者多药耐药菌感染分析

Multidrug-resistant bacteria infections in patients with diabetes

目的探讨糖尿病患者多药耐药菌感染的影响因素、病原菌分布及循证护理措施的应用,为临床提供参考依据。方法选择2011年8月-2013年8月住院治疗的糖尿病患者184例,以发生多药耐药菌感染的39例作为观察组,其他145例患者作为对照组,分析影响患者发生多药耐药菌感染的因素及病原菌分布。结果影响糖尿病患者发生多药耐药感染的因素有使用抗菌药物、合并骨髓炎、患有糖尿病足、有神经缺血性伤口以及使用三代头孢菌素,组间比较差异有统计学意义(P<0.05);39例发生多药耐药菌感染患者培养出病原菌43株,以金黄色葡萄球菌、铜绿假单胞菌、肠杆菌属为主,分别占41.86%、25.58%、23.25%;观察组抗菌药物的使用疗程(14.28±4.97)d,抗菌药物的使用种类(3.49±1.07)种,观察组抗菌药物使用疗程长,使用种类多,与对照组比较差异有统计学意义(P<0.05)。结论影响糖尿病患者发生多药耐药菌感染因素较多,临床护理应采取严格执行消毒隔离制度和无菌操作、合理使用抗菌药物、加强医务人员手卫生等培训,减少多药耐药的发生。

OBJECTIVE To explore the influencing factors for multidrug-resistant bacteria infections in the patients with diabetes,analyze the distribution of pathogens,and study the application of evidence-based nursing measures so as to provide guidance for clinical treatment.METHODS A total of 184patients with diabetes who were hospitalized for treatment from Aug 2011to Aug 2013were enrolled in the study and divided into the observation group with the 39cases of multidrug-resistant bacteria infections and the control group with 145cases without multidrugresistant bacteria infections,then the risk factors for the multidrug-resistant bacteria infections and the distribution of pathogens were analyzed.RESULTS The influencing factors for the multidrug-resistant bacteria infections in the patients with diabetes included the use of antibiotics,complication of osteomyelitis,diabetic foot,neurological ischemic wound,use of the three generations of cephalosporins,and there was significant between-group difference（P〈0.05）.A total of 43strains of pathogens have been cultured from the 39patients with multidrug-resistant bacteria infections,among which the Staphylococcus aureus,Pseudomonas aeruginosa,and Enterobacter were dominant,accounting for 41.86%,25.58%,and 23.25%,respectively.In the observation group,the antibiotics treatment course was（14.28±4.97）days,with the types of antibiotics used（3.49±1.07）types,as compared with the control group,the differences were significant（P〈0.05）.CONCLUSIONThere are a variety of influencing factors for the multidrug-resistant bacteria infections in the diabetes patients;it is necessary for the clinical nursing staff to take strict disinfection and isolation system,conform to the aseptic operation,reasonably use antibiotics,and strengthen the training of health care workers such as hand hygiene so as to reduce the incidence of multidrug-resistant bacteria infections.