ICU医院获得性肺炎感染病原菌耐药性及危险因素分析

Analysis of pathogen resistance and risk factors in ICU hospitalized patients with HAP

目的探讨ICU医院获得性肺炎(HAP)感染病原菌特点及其耐药性,分析ICU住院患者发生HAP的相关危险因素,为临床治疗HAP提供依据。方法回顾性分析2011年12月至2015年2月我院收治的405例ICU住院患者的临床资料,分析其病原菌分布、主要病原菌耐药性,单因素及多因素Logistic回归分析ICU住院患者发生HAP的相关危险因素。结果 405例ICU住院患者发生HAP 146例,感染率为36.05%,共检出病原菌184株,其中革兰阴性菌、阳性菌、真菌各125、48、11株,各占67.93%、26.09%、5.98%;金黄色葡萄球菌、肺炎链球菌对万古霉素的耐药率较低;单因素及多因素Logistic回归分析发现,应用镇静药物、入ICU时间>7 d、入ICU前后进行手术是ICU住院患者发生HAP的独立危险因素(P<0.05)。结论 ICU HAP患者感染病原菌较广,发生HAP的相关危险因素较多,需采取相应措施,合理选用抗菌药物,以降低耐药率及医院感染率。

Objective To explore the characteristics and drug resistance of pathogenic bacteria in ICU hospitalized patients with hospital acquired hospital-acquired pneumonia（ HAP）,and to analyze the relevant risk factors,in order to provide basis for the clinical treatment of HAP. Methods A total of 405 ICU hospitalized patients from December 2011 to February 2015 in our hospital were selected and the clinical data was retrospectively analyzed. The distribution of pathogens and the main pathogen resistance was analyzed. The related risk factors in ICU hospitalized patients with HAP were analyzed by univariate and multivariate logistic regression analysis. Results Totally 146 patients acquired HAP among 405 ICU hospitalized patients,infection rate being 36. 05%; 184 pathogens were detected,including gram-negative bacteria,positive bacteria and fungi being 125,48 and 11 strains,which accounted for 67. 93%,26. 09% and 5. 98%. The resistance of Staphylococcus aureus and Streptococcus pneumoniae to vancomycin was low.The univariate and multivariate logistic regression analysis found that the use of sedative drugs,the ICU time 〉7 d and patients receiving surgery were independent risk factor（ P〈0. 05） in ICU hospitalized patients. Conclusion ICU hospitalized patients infected with broad pathogens and related risk factors of HAP are abundant. Appropriate measures should be taken and rational use of antimicrobial drugs should be made to reduce resistance rates and hospital infection rates.