ICU下呼吸道多重耐药菌感染的危险因素和死亡因素分析

Analysis of the risk factors and death from multidrug resistant bacteria infection in lower respiratory tract of patients in ICU

目的:分析急诊ICU和综合ICU患者下呼吸道感染多重耐药菌的分布、耐药情况、易感因素及死亡因素。方法:回顾性分析2014年1月~2016年12月芜湖市第二人民医院急诊ICU、综合ICU收治的104例确诊为下呼吸道感染且细菌培养阳性的患者资料,根据痰标本的检验结果分为多重耐药组(MDR组)和非多重耐药组(非MDR组)。观察多重耐药菌感染的构成情况和耐药情况,分析可能导致多重耐药菌感染的危险因素,并对多重耐药组患者临床转归进行多因素Logistic回归分析。结果:104例下呼吸道感染患者痰标本检出多重耐药菌71株(68.27%),其中革兰阳性菌6株(8.45%),革兰阴性菌65株(91.55%)。前5位的多重耐药菌依次是鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、嗜麦芽黄单胞菌及大肠埃希菌。患者感染前应用抗菌药物种类、抗菌药物时间、合并慢性肺部疾病、脑卒中和有创机械通气≥7 d是多重耐药菌感染的危险因素,APACHEⅡ评分>19.5分、SOFA评分>7分、抗生素的种类是多重耐药菌感染患者死亡的独立危险因素。结论:急诊和综合ICU患者下呼吸道多重耐药菌感染发生率较高,预后较差,应根据患者的危险因素,预防和减少肺部多重耐药菌感染的发生,并根据药敏结果合理选择抗菌药物。

Objective： To analyze the pathogen distribution,incidences of multi-drug resistance,predisposing and death-related factors in patients of lower respiratory tract infection in the emergency intensive care unit（ EICU） and general ICU of Wuhu No. 2 People＇s Hospital. Methods： The data were collected from 104 patients of lower respiratory tract infections with positive sputum culture,treated in the EICU and general ICU between January 2014 and December 2016. The patients were divided into multidrug-resistant and non-multidrug-resistant group by the test results of sputum specimens. The pathogen distribution and incidences of multi-drug resistance were documented,and the risks associated with multi-drug resistance as well as clinical outcomes in patients following multi-drug resistance were analyzed using multiple logistic model. Results： A total of 71 strains of multidrug resistant bacteria were found in the sputum from the 104 patients of lower respiratory tract infections（ 68. 27%）. Six strains were Gram-positive bacteria（ 8. 45%） and 65 strains Gram-negative（ 91. 55%）. The first 5 multiple drug resistant bacteria were Acinetobacter baumanii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Xanthomonas maltophilia and Escherichia coli. The risk factors for multi-drug resistance were associated with the use antimicrobial agents before infection,duration of antimicrobial agents,concomitant chronic lung disease,stroke and invasive mechanical ventilation ≥7 d. The Acute Physiologic Assessment and Chronic Health Evaluation II（ APACHE Ⅱ） score 19. 5,Sequential Organ Failure Assessment（ SOFA） score 7 and types of antibiotics were the independent risks for death in patients following multidrug resistant bacteria infection. Conclusion： Patients of lower respiratory tract infection in EICU and general ICU in our hospital have higher incidence of multiple drug-resistance against bacteria and poorer prognosis. Management of the problems should rely on the risk factors and rational antibiotic use by drug sensitivity test as well as prevention of or reducing the incidence of multidrug resistant bacteria infection in the lung.