ICU脑卒中相关性肺炎患者感染多重耐药菌危险因素分析及病原学研究

Analysis on risk factors and etiology of MDRO infection in patients with stroke associated pneumonia in ICU

目的探讨入住ICU的脑卒中相关性肺炎(ICU-SAP)患者感染多重耐药菌(MDRO)的危险因素并分析其病原菌构成。方法搜集2013年1月至2016年6月该院158例ICU-SAP患者的病例资料,分析MDRO感染率和其病原菌构成,筛选ICU-SAP发生MDRO感染的影响因素。结果 158例ICU-SAP患者中有106例发生MDRO感染,感染率为67.1%。感染患者呼吸道标本中共分离出146株MDRO,其中革兰阳性菌31株(21.2%),革兰阴性菌115株(78.8%)。Logistic回归分析显示与ICU-SAP患者感染MDRO的因素包括SAP晚发型、ICU住院时间(≥72h)、意识障碍、吞咽障碍和急性生理学及慢性健康(APACHEⅡ)评分(>25分)。结论 ICU-SAP患者感染MDRO比例高且以革兰阴性菌为主,晚发型SAP、ICU住院时间长、存在意识障碍或吞咽障碍及疾病严重程度偏重可增加其感染风险,应加以重视和干预,以降低发病率。

Objective To investigate the risk factors of multi-drug resistant organism（MDRO） infection in the patients with stroke associated pneumonia in ICU （ICU-SAP） and to analyze the composition of pathogenic bacteria. Methods The medical re- cord data of 158 inpatients with ICU-SAP in our hospital from January 2013 to June 2016 were collected and screened the influence factors for MDRO infection occurrence in ICU-SAP. Results One hundred fity-eight cases of ICU-SAP, 106 cases developed MDRO infection,and the infection rate was 67.1 %. A total of 146 strains of MDRO were isolated, of which 31 strains（21.2 %） were Gram-positive bacteria and 115 strains（78.8 %） were Gram-negative bacteria. The Logistic regression analysis showed that the risk factors for MDRO infection in ICU-SAP patients included late-onset SAP,ICU stay time（≥72 h）, disturbance of conscious- ness,swallowing disorders and APACHE Ⅱ （≥25 points）. Conclusion The proportion of ICU-SAP patients infected with MDRO is high,and Gram-negative bacilli are the primary pathogen. These factors such as late-onset SAP,long ICU stay time,disturbance of consciousness, swallowing disorders and increased disease severity increase the MDRO infection risk,which should be paid atten- tion to in order to reduce the morbidity of MDRO infection.