呼吸衰竭患者医院感染病原菌耐药特征与相关危险因素分析

Resistance characteristics and related risk factors of nosocomial infections in respiratory failure patients

目的：探讨呼吸衰竭患者医院感染病原菌耐药特征及危险因素，为降低医院感染提供依据。方法回顾性分析2010年1月－2014年12月医院收治的900例呼吸衰竭患者临床资料，记录患者医院感染率、感染部位及病原菌对抗菌药物耐药性；采用单因素和多因素回归分析引起医院感染的独立危险因素。结果900例呼吸衰竭患者发生医院感染37例，感染率为4．1％；感染患者共分离出46株病原菌，其中革兰阴性菌36株占78．3％、革兰阳性菌7株占15．2％、真菌3株占6．5％；革兰阴性菌对头孢哌酮、头孢他啶、阿米卡星耐药率较低，均＜20．0％，对环丙沙星耐药率较高，均＞60．0％；革兰阳性菌对青霉素G、左氧氟沙星耐药率最高，为75．0％～100．0％；对替考拉宁、万古霉素敏感；logistic回归分析显示，年龄、合并基础疾病、住院时间、使用糖皮质激素是医院感染的独立危险因素，预防性使用抗菌药物是医院感染的保护因素。结论呼吸衰竭患者医院感染病原菌主要为革兰阴性性菌；应按医院感染的独立危险因素，预防控制医院感染。

OBJECTIVE To explore the resistance characteristics and related risk factors of nosocomial infections in respiratory failure patients ,so as to provide the basis for reducing nosocomial infections .METHODS Retrospective analysis of the clinical data of 900 cases of respiratory failure patients from Jan .2010 to Dec .2014 in our hospital was conducted ,and the incidence of infections ,infection sites and drug resistance of pathogens to antimicrobial drug were recorded .General information of patients were collected , single factor and multi factor regression analysis were adopted to figure out independent risk factors of nosocomial infections .RESULTS In 900 cases of respiratory failure patients ,37 cases suffered from nosocomial infections ,the infection rate was 4 .1% .Totally 46 strains of pathogenic bacteria were isolated ,including 36 strains of gram‐negative bacteria ,which accounted for 78 .3% ,and 7 strains of gram‐positive bacteria ,which accounted for 15 .2% ,and 3 strains of fungi ,which accounted for 6 .5% .The drug resistance rate of gram negative bacteria to cefoperazone ,ceftazidime ,and amikacin was low （〈20 .0% ） .While they were highly resistant to ciprofloxacin resistance with the drug resistance rate over 60 .0% .Gram‐positive bacteria were seriously resistant to penicillin G and levofloxacin with the rate from 75 .0% to 100 .0% ;and were sensitive to teicoplanin and vancomycin .Logistic regression equation showed that age ,underlying diseases ,hospitalization time ,the use of glucocorticoids were independent risk factors for hospital infections ,prophylactic antibiotics were protective factors for hospital infections . CONCLUSION Respiratory failure patients in hospital are mianly infected by gram negative bacteria .It is necessary to the prevention measures aiming at the inedpendent risk factors for the nosocomial infections .