重症监护病房患者多重耐药菌定植情况及其危险因素分析

Colonization of multiple drug resistant bacteria and related risk factors among patients in intensive care unit

目的 了解重症监护病房（ICU）患者多重耐药菌（MDROs）定植情况及其危险因素,为MDROs的预防和控制提供参考依据。方法 整群抽取东南大学附属中大医院2014年1月—2015年12月ICU收治的1143例患者进行病例收集,并采集其鼻前庭及咽拭子进行细菌培养和药敏试验。结果 ICU中1 143例患者发生MDROs定植者217例,MDROs定植发生率为18.99%;217例MDROs定植者中,发生多重耐药金黄色葡萄球菌定植者27例（12.44%）,多重耐药肺炎克雷伯菌定植者122例（56.22%）,多重耐药鲍曼不动杆菌定植者41例（18.89%）,多重耐药铜绿假单胞菌定植者27例（12.44%）;多因素非条件logistic回归分析结果显示,入ICU前抗菌药物使用种类〉2种（OR=2.011,95%CI=1.081~4.552）和入ICU前抗菌药物使用时间≥3d（OR=4.201,95%CI=2.108~5.011）是ICU患者M DROs定植发生的危险因素。结论 ICU患者M DROs定植发生率较高,以多重耐药肺炎克雷伯菌定植为主;入ICU前抗菌药物使用种类较多和入ICU前抗菌药物使用时间较长是ICU患者MDROs定植发生的主要危险因素。

Objective To investigate the status and risk factors of colonization of multiple drug resistant organisms （MDROs） among patients in intensive care unit （ICU）. Methods Using cluster sampling,we recruited 1 143 patients in an ICU in Zhongda Hospital Affiliated to Southeast University and collected nasal vestibular and throat swab samples from all the patients for bacterial culture and drug sensitivity tests from January 2014 to December 2015 ; we extracted relevant clinical data of the patients to analyze risk factors of MDROs colonization. Results MDROs colonization was identified in 217 （ 18.99% ） of the patients. Of the 217 patients with MDROs colonization, 122 （ 56. 22% ） were with the colonization of multidrug-resistant Klebsiella pneumoniae,41 （ 18. 89% ） with Acinetobacter Bauman,27 （ 12. 44% ） with Staphylococcus aureus,and 27 （12. 44% ） with Pseudomonas aeruginosa, respectively. Logistic regression analysis showed that treatment with more than 2 types of antibiotics （odds ratio EOR] =2. 011,95% confidence interval E CI] ：1.081 -4. 552） and with continuous antibiotic therapy 3 days or more （ OR =4. 201,95% CI：2. 108 - 5. 011 ） before admitted into ICU were main risk factors of MDROs colonization for the patients. Conclusion The incidence of MDROs colonization is high and Kleb- siella pneurnoniae is a dominant bacteria of the colonization among patients in ICU;multiple and continuous antibiotics treatment before admitted into ICU are major risk factors of the MDROs colonization.