多中心多重耐药菌医院感染肺炎危险因素研究

Multicenter study on risk factors for multidrug-resistant organism healthcare-associated pneumonia

目的探索住院患者发生多重耐药菌（MDRO）医院感染肺炎的危险因素。方法对2013年4月1日—12月31日北京、上海、长沙和广西四地区22所三甲医院全部住院患者5种MDRO（分别为MRSA、MDRPA、MDRAB、ESBL KP、ESBL E.coli）及对应敏感菌（MSSA、PA、AB、KP、E.coli）引起的医院感染肺炎患者进行调查（耐药组：发生5种MDRO医院感染肺炎的患者;敏感组：发生对应5种敏感菌医院感染肺炎的患者）,分析发生MDRO医院感染肺炎的危险因素,比较耐药组和敏感组患者预后、住院花费和住院时间。结果共1 656例住院患者符合纳入标准,其中43例（2.60%）患者发生耐药菌和敏感菌的混合感染;耐药组927例（55.98%）,敏感组772例（46.62%）。采用logistic回归模型进行多因素分析,结果显示,患者入住重症监护室（ICU）史[OR95%CI：1.55（1.14～2.11）]、机械通气史[OR95%CI：1.45（1.15～1.84）]、动静脉置管[OR95%CI：1.29（1.02～1.63）]、进行纤维支气管镜操作[OR95%CI：1.46（1.02～2.09）]、使用抗菌药物[OR95%CI：1.63（1.20～2.22）]、患有慢性肺部疾病[OR95%CI：1.54（1.13～2.10）]和慢性心脑血管疾病[OR95%CI：1.42（1.15～1.74）]是发生MDRO医院感染肺炎的独立危险因素。耐药组患者较敏感组住院时间平均延长5.89 d,住院费用增加40 739.30元,抗感染药物费用增加2 805.80元;耐药组患者预后差于敏感组,死亡风险是后者的1.66倍（OR95%CI：1.16～2.35）。结论入住ICU、进行各种侵入性操作、使用抗菌药物,以及患慢性肺部疾病和心脑血管疾病均会增加患者发生MDRO医院感染肺炎的风险。

Objective To assess the risk factors of multidrug-resistant organism（MDRO）healthcare-associated pneumonia（HCAP）.Methods The case-control study was conducted in patients admitted to 22 hospitals in4 cities between April 1,2013 and December 31,2013,patients with HCAP caused by MDRO（MRSA,MDRPA,MDRAB,ESBL KP,ESBL E.coli）（drug-resistant group）and drug-sensitive organisms（MSSA,PA,AB,KP,E.coli）（drugsensitive group）were surveyed.Univariate and multivariate statistical analysis methods were used to evaluate the risk factors for MDRO HCAP.The prognosis,cost and length of hospital stay between drug-resistant group and drug-sensitive group were compared.Results A total of 1 656 patients were included in the study,including43 patients（2.60%）with mixed infection caused by both drug-resistant and drug-sensitive organisms;there were 927 cases（55.98%）in drug-resistant group and772 cases（46.62%）in drug-sensitive group.Logistic regression model revealed that admission to ICUs（OR95%CI：1.55[1.14-2.11]）,mechanical ventilation（OR95%CI：1.45[1.15-1.84]）,arteriovenous catheterization（OR95%CI：1.29[1.02-1.63]）,fiberbronchoscopy（OR95%CI：1.46[1.02-2.09]）,antimicrobial use（OR95%CI：1.63[1.20-2.22]）,chronic lung diseases（OR95%CI：1.54[1.13-2.10]）,and chronic cardiovascular and cerebrovascular diseases（OR95%CI：1.42[1.15-1.74]）were independent risk factors for MDRO HCAP.Compared with drug-sensitive group,drug-resistant group prolonged length of hospital stay by an average of 5.89 days,increased hospitalization and antimicrobial expense by $40 739.30 and$2 805.80 respectively;prognoses was worse,risk factor was 1.66-fold of drug-sensitive group（OR95%CI：1.16-2.35）.Conclusion Admission to ICUs,invasive operations,antimicrobial use,chronic lung diseases and chronic cardiovascular and cerebrovascular diseases can increase the risk of MDRO HCAP.