重症胸部创伤术后机械通气患者肺部多重耐药菌感染病原菌分布及危险因素分析

Analysis of pathogenic bacteria distribution and influencing factors of pulmonary multidrug-resistant bacterial infection of mechanically ventilated patients after severe chest trauma

目的:探讨重症胸部创伤术后机械通气并发肺部多重耐药菌(MDR)感染的病原学特点及危险因素。方法:回顾分析221例重症胸部创伤术后机械通气并发肺部感染者的临床资料、病原菌分布和耐药性。采用单因素和多因素Logistic分析MDR感染的危险因素。结果:MDR感染率为46.61%,以鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌和肺炎克雷伯菌常见。药敏结果显示,G-菌对碳青霉烯类、替加环素、阿米卡星耐药率较小,G+菌对莫西沙星、利福平和复方新诺明耐药率较小,未检出万古霉素和利奈唑胺耐药的G+菌。单因素及多因素分析显示,昏迷时间≥7 d(OR=3.321)、APACHE-Ⅱ评分≥25分(OR=2.716)、合并慢性呼吸系统疾病(OR=2.378)、预防性使用抗菌药物(OR=2.108)、机通气时间≥7 d(OR=1.846)和低蛋白血症(OR=1.772)是MDR感染的独立危险因素(P<0.05)。结论:重症胸部创伤术后机械通气并发肺部MDR感染率较高,其中昏迷时间≥7 d、APACHE-Ⅱ评分≥25分、慢性呼吸系统疾病、预防用抗菌药物、呼吸机通气时间≥7 d及低蛋白血症是MDR感染的高危因素。

OBJECTIVE To investigate the pathogenic characteristics and risk factors of pulmonary multidrug-resistant bacteria(MDR)infection of mechanically ventilated patients after severe chest trauma.METHODS A retrospective case series study was conducted in 221 patients with pulmonary infection of severe chest trauma surgically with mechanically ventilated treated.The distribution and drug resistance of pathogens were analyzed.Univariate analysis and multivariate Logistic analysis were used to analyze the risk factors of MDR infection.RESULTS The infection rate of MDR was 46.61%,and the main pathogens were Acinetobacter baumannii,Pseudomonas aeruginosa,Staphylococcus aureus and Klebsiella pneumoniae.The drug sensitivity showed that carbapenems,tigacycline and amikacin were less resistant to G;bacteria,moxifloxacin,rifampicin and cotrimoxazole were less resistant to G;bacteria,and G;bacteria was not detected against vancomycin and linezolid.Univariate and Logistic regression analysis showed that coma time≥7 days(OR=3.321),APACHEⅡscore≥25 points(OR=2.716),chronic respiratory diseases(OR=2.378),preventive use of antibiotics(OR=2.108),machine ventilation time≥7 days(OR=1.846)and hypoalbuminemia(OR=1.772)were independent risk factors of pulmonary MDR infection in severe chest trauma patients with mechanically ventilated(P<0.05).CONCLUSION The incidence of MDR infection in the lung is higher in severe chest trauma patients with mechanically ventilated,Coma time≥7 days,APACHE-ⅡScore≥25 points,chronic respiratory disease,prophylactic antibiotics,mechanical ventilation time≥7 days,and hypoproteinemia are independent risk factors for MDR infection.