神经外科ICU患者医院感染耐碳青霉烯肠杆菌科细菌耐药性及危险因素分析

Analysis of drug resistance and risk factors of carbapenem-resistant Enterobacteriaceae in patients with neurosurgical intensive care unit

目的:研究神经外科重症监护病房(NICU)患者医院感染耐碳青霉烯肠杆菌科细菌(CRE)的耐药情况及感染相关危险因素。方法:分别对2017年1月-2018年12月我院NICU医院感染CRE、碳青霉烯敏感肠杆菌科细菌(CSE)及无医院感染患者临床资料进行分析,每组55例。感染相关危险因素采用单因素及多因素Logistic回归分析。结果:我院NICU分离的CRE主要来源于痰标本,对替加环素及阿米卡星的敏感率较高。单因素分析表明电解质紊乱、肝功能异常、低蛋白血症、腰椎穿刺、气管镜、静脉置管、去骨瓣减压术、年龄、ICU住院天数、呼吸机使用时长在NICU患者CRE感染组与无医院感染组间差距有统计学意义(P<0.05);肝功能异常、高龄、行腰椎穿刺及气管镜为NICU患者CRE感染的独立危险因素。结论:临床应尽可能减少不必要的有创性操作,及时改善患者低蛋白血症及电解质紊乱,合理用药减少对患者肝、肾毒性,加强感控措施,降低NICU患者院内CRE的感染。

Objective:To analyze the drug resistance,clinical characteristics and infection-related risk factors of carbapenem-resistant Enterobacteriaceae bacteria(CRE)in neurosurgery intensive care unit(NICU)patients.Methods:Analyze the clinical data of patients with CRE infected(n=55)of NICU in our hospital from January 2017 to December 2018,matching carbapenems sensitive Enterobacteriaceae bacteria(CSE)infection group(n=55)in NICU.Meanwhile patients without nosocomial infection(n=55)in NICUwere selected as a control group.The risk factors of infection were analyzed by univariate and multivariate Logistic regression analysis.Results:The CRE isolated from NICU in our hospital mainly came from sputum samples,and the sensitive rate to tegacycline and amikacin was high.Univariate analysis showed that electrolyte disturbance,abnormal liver function,hypoproteinemia,lumbar puncture,tracheoscopy,venous catheterization,decompressive craniotomy,age,length of stay in NICU and length of ventilator use were all risk of CRE infection in NICU patients.Multivariate Logistic regression analysis showed that abnormal liver function,advanced age,lumbar puncture and tracheoscopy are the independent risk factors of CRE infection(P<0.05).Conclusion:The rational use of antibiotics should be strengthened in clinic,and unnecessary and invasive operation should be reduced as much as possible.Timely improvement of hypoproteinemia and electrolyte disturbance,rational use of drugs to reduce the toxicity of liver and kidney,strengthen sensory control measures,reduce CRE infection in NICU patients.