急诊科病房院内感染耐药研究及危险因素分析

Study of drug resistance and analysis of risk factors for a nosocomial infection in the Emergency Department

目的分析急诊科病房院内感染耐药研究及危险因素,对于临床感染预防及治疗提供指导。方法收集394例急诊科病房患者临床资料,采用全自动细菌微生物鉴定仪鉴定患者感染病原菌类型。采用K-B纸片扩散法检测病原菌的耐药情况,并采用统计学分析危险因素。结果 394例患者中,院内感染91例,感染率为23.10%。其中呼吸道感染患者32例,外科伤口感染患者23例,泌尿道感染患者15例,口腔感染患者11例,皮肤软组织感染7例,腹腔内感染患者3例,分别占35.16%、25.27%、16.48%、12.09%、7.69%和3.30%。培养出到68株病原菌,阳性率74.73%,其中革兰阴性菌39株,革兰阳性菌27株,真菌2株。铜绿假单胞菌17株,肺炎克雷伯菌12株,鲍曼不动杆菌7株,其他革兰阴性菌3株;金黄色葡萄球菌16株,粪肠球菌9株,其他革兰阳性菌2株,白色假丝酵母菌2株。铜绿假单胞菌对头孢吡肟、氨曲南、环丙沙星、阿米卡星、亚胺培南的耐药率分别为29.41%、58.82%、35.29%、29.41%和11.76%;肺炎克雷伯菌对头孢吡肟、氨曲南、环丙沙星、阿米卡星、亚胺培南的耐药率分别为41.67%、50.00%、50.00%、16.67%和8.33%;金黄色葡萄球菌对左氧氟沙星、加替沙星耐药率分别为56.25%和25.00%;粪肠球菌对左氧氟沙星、加替沙星耐药率分别为44.44%和11.11%。未检出对替考拉宁、万古霉素耐药金黄色葡萄球菌和粪肠球菌。除性别外,年龄、病情、侵袭性操作、激素使用情况都是影响院内感染发生的危险因素。结论在急诊科病房院内感染患者中,呼吸道是主要感染部位,革兰阴性菌居多。临床应合理使用抗菌药物以控制耐药性发展及耐药株传播。控制危险因素可预防感染发生及耐药性发展。

Objectives To study drug resistance and analyze risk factors for a nosocomial infection in the Emergency Department to guide the clinical prevention and treatment of infections. Methods Clinical data on 394 patients in the Emergency Department were collected, and the types of pathogens in patient samples were identified using an automated microbiological assay. The K-B disk diffusion method was used to detect the drug resistance of pathogens, and risk factors were analyzed statistically. Results Of 394 patients studied, 91 developed a nosocomial infection for a rate of infection of 23.10%. The 91 patients included 32 patients(35.16%) with a respiratory infection, 23 with a surgical wound infection(25.27%), 15(16.48%) with a urinary tract infection, 11(12.09%) with an oral infection, 7(7.69%) with a skin or soft tissue infection, and 3(3.30%) with an intra-abdominal infection. Sixty-eight strains of pathogens were cultured from patients at a rate of 74.73%. The 68 strains included 39 strains(57.35%) of Gram-negative bacteria, 27 strains(39.71%) of Gram-positive bacteria, and 2 strains(2.94%) of fungi. Gram-negative bacteria included 17 strains(25.00%) of Pseudomonas aeruginosa, 12 strains(17.65%) of Klebsiella pneumoniae, 7 strains of(10.29%) Acinetobacter baumannii, and 3 strains(4.41%) of other Gram-negative bacteria. Gram-positive bacteria included 16 strains(23.53%) of Staphylococcus aureus, 9 strains(13.24%) of Enterococcus faecalis, and 2 strains(2.94%) of other Gram-positive bacteria. Fungi included 2 strains(2.94%) of Candida albicans. P. aeruginosa was resistant to cefepime at a rate of 28.57%, to aztreonam at a rate of 71.43%, to ciprofloxacin at a rate of 57.14%, to amikacin at a rate of 42.86%, and to imipenem at a rate of 28.57%. K. pneumoniae was resistant to cefepime at a rate of 41.67%, to aztreonam at a rate of 50.00%, to ciprofloxacin at a rate of 50.00%, to amikacin at a rate of 16.67%, and to imipenem at a rate of 8.33%. S. aureus was resistant to levofloxacin at a rate of 56.25%, to gatifloxacin at a rate of 25.00%, to teicoplanin at a rate of 0.00%, and to vancomycin at a rate of 0.00%. E. faecalis was resistant to levofloxacin at a rate of 44.44%, to gatifloxacin at a rate of 11.11%, to teicoplanin at a rate of 0.00%, and to vancomycin at a rate of 0.00%. With the exception of gender, age, condition, invasive surgery, and hormone use all were risk factors for development of a nosocomial infection. Conclusion In patients with a nosocomial infection in the Emergency Department, the respiratory tract was the main site of infection and infections were most often caused by Gram-negative bacteria. Antimicrobials should be used rationally to control the development of drug resistance and the spread of drug-resistant strains. Age, condition, invasive surgery, antibiotic use, and hormone use are risk factors for development of a nosocomial infection. Control of risk factors can prevent the occurrence of infection and the development of drug resistance.