ICU脑卒中呼吸机相关性肺炎患者多重耐药菌感染危险因素分析

Analysis of risk factors of multi-drug resistant bacteria infection in stroke patients with ventilator-associated pneumonia in ICU

目的探讨ICU脑卒中呼吸机相关性肺炎患者多重耐药菌感染危险因素。方法选取2017年5月至2019年3月在我院ICU进行脑卒中治疗的患者381例,了解ICU脑卒中患者发生呼吸机相关性肺炎及多种耐药菌感染情况,并对相关危险因素进行分析。结果381例脑卒中患者中,出现呼吸机相关性肺炎患者198例,发生率为51.97%。198例患者中142例患者检测出多重耐药菌,多重耐药菌感染率为71.72%。198例患者中共计检测菌株267株,其中多重耐药菌205株,占全部菌株的76.78%。单因素分析结果显示,多重耐药菌感染危险因素包括患者意识水平、伴有糖尿病、呼吸机相关性肺炎类型、预防使用抗生素、留置胃管、置入人工气道、呼吸机通气时间、ICU治疗时间及APACHEⅡ评分(P<0.05);多因素logistic回归分析结果显示,患者伴有意识障碍、呼吸机通气时间≥7 d、ICU治疗时间≥7 d、晚发型呼吸机相关性肺炎及APACHEⅡ评分≥25分为多重耐药菌感染的独立危险因素(P<0.05)。结论目前ICU脑卒中呼吸机相关性肺炎发病率仍较高,脑卒中患者伴有意识障碍、呼吸机通气时间≥7 d、ICU治疗时间≥7 d、晚发型呼吸机相关性肺炎及APACHEⅡ评分≥25分为多重耐药菌感染的独立危险因素。

Objective To explore the risk factors of multi-drug resistant bacteria infection in stroke patients with ventilator-associated pneumonia in ICU.Methods To select 381 cases of patients who were treated for stroke in the ICU of our hospital from May 2017 to March 2019was set as the study subjects to understand the ventilator-associated pneumonia and multiple drug-resistant bacteria infections in ICU stroke patients,and analyze the related risk factors.Results Among the 381 cases of stroke patients,198 cases of patients had ventilator-associated pneumonia,with an incidence rate of 51.97%.Multi-drug-resistant bacteria were detected in 142 cases of the 198 cases of patients,and the infection rate of multi-drug-resistant bacteria was 71.72%.A total of 267 strains were detected in 198 cases of patients,of which 205 were multi-drug resistant bacteria,accounting for 76.78%of all strains.Univariate analysis showed that the risk factors for multi-drug resistant bacteria infection included the patient's level of consciousness,concurrent diabetes,the type of ventilator-associated pneumonia,prevention and use of antibiotics,indwelling gastric tube,artificial airway placement,ventilator ventilation time,ICU treatment time and APACHEⅡscore(P<0.05).Multivariate logistic regression analysis showed that in stroke patients,consciousness disturbance,ventilator ventilation time≥7 days,ICU treatment time≥7 days,late-onset ventilator-associated pneumonia and APACHEⅡscore≥25 points were the independent risk factors for multi-drug resistant bacteria infection(P<0.05).Conclusion At present,the incidence of ventilator-associated pneumonia in ICU was still higher.In stroke patients,consciousness disturbance,ventilator ventilation time≥7 days,ICU treatment time≥7 days,late-onset ventilator-associated pneumonia and APACHEⅡscore≥25 points were the independent risk factors for multi-drug resistant bacteria infection.