颅脑损伤患者术后多重耐药菌感染的影响因素及病原学特点分析

Influencing factors and etiological characteristics of postoperative multidrug-resistant organism infection in patients with traumatic brain injury

目的分析颅脑损伤术后多重耐药菌(MDRO)感染的相关危险因素及病原学特点,探讨其护理对策。方法采用便利抽样法,于2019年1月—2021年1月选取郑州大学第一附属医院收治的478例颅脑损伤术后感染患者为研究对象,收集患者性别、年龄、基础疾病、感染类型等资料,根据病原菌是否为MDRO将患者分为MDRO感染组(n=69)与非MDRO感染组(n=409)。采用二项Logistic回归分析MDRO感染的相关危险因素。结果Logistic回归分析结果显示,合并脑血管病、合并营养不良、有休克史、有侵入性操作、联合使用抗生素是MDRO感染的独立危险因素(P<0.05)。478例患者感染样本共检出病原菌516株,目标菌株386株,其中MDRO 73株(18.91%),包含金黄色葡萄球菌22株(30.14%)、铜绿假单胞菌14株(19.18%)、肺炎克雷伯菌13株(17.81%)、大肠埃希菌11株(15.07%)、鲍曼不动杆菌10株(13.70%)、粪肠球菌3株(4.11%);感染部位以下呼吸道为主,其次为泌尿道、伤口和上呼吸道。结论合并基础疾病、有侵入性操作、联合应用抗生素均会增加颅脑损伤患者术后MDRO感染风险;金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌等为常见的MDRO。临床护理人员应加强颅脑损伤患者病情监测,做好隔离防护等,预防患者发生呼吸系统、泌尿系统和伤口感染。

Objective To analyze the risk factors and etiological characteristics of multidrug-resistant organism(MDRO)infection after traumatic brain injury,and to explore its nursing countermeasures.Methods From January 2019 to January 2021,convenience sampling was used to select 478 patients with post-traumatic infection in the First Affiliated Hospital of Zhengzhou University as the research object.The patients'gender,age,underlying diseases,and infection types were collected,and the patients were divided into MDRO infection group(n=69)and non-MDRO infection group(n=409)according to whether the pathogen was MDRO.Binary Logistic regression was used to analyze the risk factors of MDRO infection.Results Logistic regression analysis showed that cerebrovascular disease,malnutrition,history of shock,invasive operation,and combined use of antibiotics were independent risk factors for MDRO infection,and the difference was statistical(P<0.05).A total of 516 strains of pathogenic bacteria were detected in the infected samples of 478 patients,of which 386 were target strains,involving 73 strains of MDRO(18.91%),including 22 strains of Staphylococcus aureus(30.14%),14 strains of Pseudomonas aeruginosa(19.18%),13 strains of Klebsiella pneumoniae(17.81%),11 strains of Escherichia coli(15.07%),10 strains of Acinetobacter baumannii(13.70%),3 strains of Enterococcus faecalis(4.11%).The lower respiratory tract was the main site of infection,followed by the urinary tract,wound and upper respiratory tract.Conclusions Combination of underlying diseases,invasive operation,and combined use of antibiotics all increase the risk of postoperative MDRO infection in patients with traumatic brain injury.Staphylococcus aureus,Pseudomonas aeruginosa,and Klebsiella pneumoniae are common MDROs.Clinical nurses should strengthen the monitoring of the condition of patients with traumatic brain injury,do a good job of isolation protection,to prevent the occurrence of respiratory system,urinary system and wound infection in patients.