影响神经内科患者多重耐药菌感染的危险因素分析

Risk Factor Analysis of Multi-drug Resistant Bacteria Infection in Neurology Patients

目的探讨神经内科患者多重耐药菌(MDRB)感染的特点及其高危因素,提出早期预防措施。方法选取515例神经内科院内感染病例,依据其住院期间是否发生MDRB感染将其分为MDRB组和非MDRB组;分析神经内科患者MDRB的感染率病原菌分布,采用χ2检验和逐步Logistic回归法分别筛选神经内科患者发生MDRB感染的危险因素。结果神经内科患者MDRB感染发生率为33.79%(174/515),MDRB感染以大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌等为主;影响神经内科患者MDRB感染的危险因素包含年龄(OR=2.344)、糖尿病(OR=3.089)、意识障碍(OR=2.948)、误吸误呛(OR=4.367)、机械通气(OR=3.900)、动静脉置管(OR=3.586)、联合广谱抗生素(OR=5.181)等。结论神经内科院内感染病例中MDRB感染比例超过三分之一,且影响MDRB感染的高危因素较多,应尽早采取相应预防措施,降低神经内科患者MDRB感染比例,改善患者的预后。

Objective To explore the characteristics and high risk factors of multi-drug resistant bacteria(MDRB)infection in neurology patients,and to provide early prevention measures.Methods A total of 515 cases of neurolgy patients with nosocomial infection were included and divided into MDRB group and non-MDRB group according to whether or not MDRB infection happened during hospitalization.The infection rate and distribution of MDRB were analyzed,and the risk factors of MDRB infection were respectively screened byχ2 test and stepwise Logistic regression method.Results The incidence rate of MDRB infection in neurology patients with nosocomial infection was 33.79%(174/515),and MDRB were mainly Escherichia coli,klebsiella pneumoniae and Acinetobacter baumannii.The risk factors of MDRB infection in neurolgy patients included age(OR=2.344),diabetes mellitus(OR=3.089),disturbance of consciousness(OR=2.948),aspiration and choking by mistake(OR=4.367),mechanical ventilation(OR=3.900),arteriovenous catheterization(OR=3.586)and combined with broad-spectrum antibiotics(OR=5.181).Conclusion MDRB infection happens in more than one third of the neurology patients with nosocomial infection,and there are many high risk factors.Corresponding preventive measures should be early carried out to reduce the incidence of MDRB infection in neurology patients and to improve prognosis of patients.