重症监护病房重型颅脑损伤昏迷患者肺部多重耐药菌感染现状及影响因素分析

Current status of multi-drug resistant bacteria infection in the lungs of patients undergoing severe craniocerebral injury and coma in intensive care unit and analysis of its influencing factors

目的探讨重症监护病房重型颅脑损伤昏迷患者肺部多重耐药菌(MDROS)感染现状及相关影响因素,为临床MDROS感染的预防及控制提供依据。方法选取徐州医科大学附属医院2019年5月—2020年2月ICU收治的重型颅脑损伤昏迷患者106例,收集患者临床基础资料,采集痰液标本行细菌培养及药敏试验,总结患者MDROS感染现状,分析MDROS感染相关因素。结果 ICU病房106例重型颅脑损伤昏迷患者中,肺部MDROS感染的感染率为13.21%(14/106)。14例患者送检的样本中共分离检出MDROS 45株,其中革兰阴性(G-)杆菌32株(71.11%),革兰阳性(G+)球菌13株(28.89%);多因素分析结果显示,合并基础病、合并胸部外伤、气管切开及抗菌药物使用不合理是重型颅脑损伤昏迷患者肺部MDROS感染的主要影响因素。结论年龄、合并基础病、合并胸部外伤、气管切开及抗菌药物使用不合理均为重型颅脑损伤昏迷患者肺部MDROS感染的影响因素,需针对上述影响因素及MDROS病原菌类型给予针对性预防,以此降低其感染率。

Objective To explore the current status of multi-drug resistant bacteria(MDROS)infection in the lungs of patients undergoing severe craniocerebral injury and coma in intensive care unit and related influencing factors,and to provide a basis for the prevention and control of clinical MDROS infection.Methods A total of 106 patients who underwent severe craniocerebral injury and coma and were admitted to the ICU from May 2019 to February 2020 in the Affiliated Hospital of Xuzhou Medical University were selected.The basic clinical data of the patients were collected,sputum samples were collected for bacterial culture and drug sensitivity test,and the current status of MDROS infection of the patients was summarized to analyze the related factors of MDROS infection.Results Among 106 cases of patients undergoing severe craniocerebral injury and coma in ICU ward,the infection rate of lung MDROS infection was 13.21%(14/106).A total of 45 MDROS strains were isolated and detected in the samples submitted by 14 patients,including 32 Gram-negative(G--)bacilli(71.11%)and 13 Gram-positive(G+)cocci(28.89%).The results of multivariate analysis showed that the combined with underlying diseases,combined with chest trauma,tracheotomy,and unreasonable use of antibacterial drugs were the main influencing factors of lung MDROS infection in patients undergoing severe craniocerebral injury and coma.Conclusion The age combined with underlying diseases,combined with chest trauma,tracheotomy,and unreasonable use of antibacterial drugs were the influencing factors of lung MDROS infection in patients undergoing severe craniocerebral injury and coma,it was necessary to provide targeted prevention for the above influencing factors and the types of MDROS pathogens to reduce the infection rate.