ICU和呼吸科患者感染鲍曼不动杆菌危险因素研究

Risk factors of Acinetobacter Baumannii nosocomial infection in ICU and respiratory department

目的研究患者院内感染鲍曼不动杆菌(Acinetobacter Baumanii, AB)的危险因素。方法对ICU和呼吸科6 017例患者的临床资料进行回顾性总结和分析,了解其AB院内交叉感染率和危险因素,为院内感控提供理论依据。结果呼吸科共5 002例,呼吸科感染率是0.59%(30例),ICU共1 015例,ICU感染率是19.70%(200例),差异有统计学意义(P<0.05)。单因素分析,"气道开放"、"广谱抗生素治疗"、"合并基础疾病"是AB感染的危险因素。Logistic回归分析,"气道开放"是独立危险因素。"气道开放"使得两科患者感染率显著增加,但在ICU感染率高于呼吸科,差异有统计学意义(P<0.05)。有基础疾病与无基础疾病患者感染率,在ICU与呼吸科内比较差异均无统计学意义(P>0.05),但无论是否有基础疾病,在ICU感染率均高于呼吸科,差异有统计学意义,(P<0.05)。同样使用广谱抗生素治疗,在ICU感染率高于呼吸科,差异有统计学意义(P<0.05)。结论 "气道开放"是院内感染AB的关键环节,"广谱抗生素治疗"、"合并基础疾病"是防控鲍曼不动杆菌感染的重要环节,应针对性管理,尤其是ICU。

Objective To study the risk factors of nosocomial infection with Acinetobacter baumannii(AB).Methods The clinical data of 6 017 patients in ICU and respiratory department(RD) were retrospectively analyzed to understand the cross infection rate and risk factors with AB nosocomial infection,and we provide a theoretical basis for hospital infection control.Results There were 5 002 cases in RD,the infection rate was 0.59%(30 cases),1 015 cases in ICU and the infection rate was 19.70%(200 cases).The infection rate of ICU was significantly higher than RD(P<0.05).Single factor analysis showed that, "airway opening", "broad-spectrum antibiotic treatment", "combined with basic diseases" were the risk factors of AB infection.In Logistic regression analysis, "airway opening" was an independent risk factor. "Airway opening" significantly increased the infection rate of patients in the two departments,but the infection rate in ICU was significantly higher than that in RD(P<0.05).Infection rate of patients with basic diseases vs patients without basic diseases,the difference of infection rate were not significantly different(P>0.05);But whether or not there were basic diseases,the infection rate in ICU was significantly higher than in RD(P<0.05).We also used broad-spectrum antibiotics,the infection rate in ICU was significantly higher than in RD(P<0.05).Conclusion "Airway opening" is a key link in nosocomial infection of AB, "broad-spectrum antibiotic treatment" and "combination of basic diseases" were important factors in the prevention and control of Acinetobacter baumannii infection,risk factors should be managed,especially in ICU.