重症监护病房卒中相关性肺炎发生非发酵菌感染的危险因素及耐药性研究

Risk factors and drug resistance study of stroke associated pneumonia with non-fermentative bacteria infection in intensive care unit

目的探讨重症监护病房卒中相关性肺炎（SAP）患者发生非发酵菌感染的危险因素及非发酵菌的耐药情况。方法回顾性分析2010年7月-2013年7月我院重症监护病房内122例SAP患者的临床资料，通过χ^2检验比较重症监护病房SAP患者在不同因素之间非发酵菌感染率的差异，选取差异有统计学意义的因素进行多因素回归分析。通过药物敏感试验检测非发酵菌菌株的分布及耐药表型。结果单因素分析发现，SAP类型、发病场所分类、意识水平、气管插管／切开、留置胃管、预防性应用抗生素等因素差异有统计学意义（P〈0．05）。多因素回归分析发现，气管插管／切开、留置胃管差异有统计学意义（P〈0．05）；122例重症监护病房内SAP患者中，分离出153株细菌，其中非发酵菌62株，前2位为鲍曼不动杆菌、铜绿假单胞菌。结论气管插管／切开、留置胃管是重症监护病房SAP患者发生非发酵菌感染的独立危险因素；非发酵菌是本地区重症监护病房SAP患者的主要病原菌，其中泛耐药菌株所占比例较高。

Objective To provide reference basis for clinical treatment,the risk factors,drug resistance of non-fermentative bacteria of stroke associated pneumonia（SAP） patients with non-fermentative bacteria infection in intensive care unit were discussed. Methods A retrospective study was designed to analyze the clinical data of 122 patients with SAP in intensive care unit from July 2010 to July 2013. Comparison in non-fermentative bacteria infection rate of stroke associated pneumonia patients in intensive care unit between different factors by ehi square test. Muhivariable regression analysis was used after univariate analysis. Strain distribution and resistance phenotype of non-fermentative bacteria were investigated. Results Univafiate analysis indicated that there was statistical difference between the two groups divided by SAP type, location classification, level of consciousness, trachea cannula/traeheotomy, indwelling gastric tube and prophylactic antibiotics （ P 〈 0.05 ）. Muhivariable regression analysis indicated that there was statistical significant in trachea eannula/tracheotomy and indwelling gastric tube（ P 〈 0.05 ）. There were 153 strains in 122 patients with SAP in intensive care unit, including 62 non-fermentative bacteria, and the top two microorganisms were Acinetobacter banmannii and Pseudomonas aeruginosa. Conclusion Trachea cannula/tracheotomy and indwelling gastric tube are independent risk factors associated with SAP patients with non-fermentative bacteria infection in intensive care unit. Non- fermentative bacteria is the main pathogenic bacteria of stroke SAP patients in intensive care unit in the local area, and extensively drug resistant strains accounted for a higher proportion.