重症监护病房内耐甲氧西林金黄色葡萄球菌感染现状分析

Status analysis of methicillin-resistant staphylococcus aureus infection in an intensive care unit

目的：研究重症监护病房（ICU）耐甲氧西林金黄色葡萄球菌（MRSA）感染的发生率和危险因素,为采取措施预防与控制MRSA感染提供科学依据。方法：2012-2013年天津市某三级甲等医院综合ICU内MRSA感染患者作为病例组,非MRSA感染患者作为对照组,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;应用非条件Logistic回归分析对资料进行单因素分析与多因素分析,寻找MRSA感染的独立危险因素。结果：MRSA感染发生率为62.79%,其中,2012年发生率为68.18%,2013年发生率为57.14%,MRSA感染部位以下呼吸道为主;Logistic回归统计分析显示：年龄（OR=1.047,95%CI：1.009～1.086）、ICU住院时间（OR=1.050,95%CI：1.012～1.089）、使用激素/免疫抑制剂（OR=2.853,95%CI：1.177～6.911）、机械通气（OR=4.918,95%CI：1.175～20.583）、抗菌药物使用超过7 d（OR=3.257,95%CI：1.055～10.058）是MRSA感染的独立危险因素。结论：高龄、长期入住ICU、进行机械通气、使用激素/免疫抑制剂、长期使用抗菌药物是ICU内MRSA感染的危险因素。

Objective：To study the incidence rate and risk factors of infection caused by methicillin-resistant staphylococcus aureus （MRSA） in the intensive care unit （ICU） so as to provide scientific data for measures to prevent and control MRSA infections. Methods：From Jan 1,2012 to Dec 31,2013,the patients with MRSA infections in general ICU were selected as the case group while the patients without MRSA infections in general ICU were set as the control group;by means of epidemiological survey,the variables and risk factors were determined according to the review,advice by experts and work experience. Non-conditional logistic regression analysis model was used for single factor and multi-factor analysis to acquire independent risk factors of MRSA infections in ICU. Results：The results showed that the incidence rate was 62.79%. Among them,the incidence rate in 2012 was 68.18%,while the incidence rate in 2013 was 57.14%. The lower respiratory tract was the major part in MRSA infection. Logistic regression analysis showed that age （OR=1.047,95%CI：1.009～1.086）, length of ICU stay （OR=1.050,95%CI：1.012～1.089）, steroid administration （OR=2.853,95%CI：1.177～6.911）,mechanical ventilation（MV）（OR=4.918,95%CI：1.175～20.583） and duration of drug therapy longer than 7 days（OR=3.257,95%CI：1.055～10.058） were the independent risk factors. Conclusion：Age, length of ICU stay , use of hormones , mechanical ventilation and long-term use of antimicrobial agents are the risk factors for the bacterial infection in ICU.