普外科无菌体液多重耐药菌特征及混合感染的危险因素分析

Analysis of characteristics of multidrug resistant bacteria and risk factors of mixed infection in sterile body fluids of general surgery

目的 探讨普通外科无菌体液病原菌感染特征以及混合感染的危险因素和预后,为降低医院感染的发生率和院感防控提供依据。方法 回顾性分析普通外科住院且无菌体液培养阳性患者的临床资料、病原学分布以及多重耐药菌特征,根据分离出病原菌的数量分为单一感染组和混合感染组,2组资料进行单因素χ2检验后,用多因素logistic回归模型进行多元分析筛选混合感染的危险因素。结果 共纳入882例患者,共检出1 075株病原菌,其中革兰氏阳性菌350株(32. 56%),革兰氏阴性菌622株(57. 86%),念珠菌85株(7. 91%),厌氧菌18株(1. 67%),排前5位的病原菌主要为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、肠球菌属以及念珠菌。单一感染700例(79. 37%),混合感染182例(20. 63%),混合感染主要以大肠埃希菌+肠球菌属以及大肠埃希菌+肺炎克雷伯菌组合感染模式为主。与单一感染组相比,混合感染组多重耐药菌检出率明显升高(P <0. 05),且混合感染组患者住院时间明显延长(P <0. 05),病死率明显升高(P <0. 05)。多因素结果筛选显示,高龄、恶性肿瘤、多脏器功能衰竭、基础疾病≥2种、侵入性治疗、近期住院超过7 d以及多重耐药菌感染是无菌体液混合感染的独立影响因素(P <0. 05)。结论 普通外科患者无菌体液分离的病原菌种类多,耐药形势严峻,影响普外科混合感染的因素较多,根据监测结果应采取针对性干预措施,可降低混合感染发生率,缩短患者住院时间,降低病死率。

Objective To analyze the characteristics of pathogenic bacteria infection in sterile body fluids in general surgery and the risk factors and prognosis of mixed infections in order to reduce the incidence of nosocomial infection and provide basis for the prevention and control of nosocomial infections.Methods The clinical data,pathogenic distribution and characteristics of multidrug resistant bacteria of patients hospitalized in general surgery and positive sterile body fluid culture were retrospectively analyzed.According to the number of isolated pathogens,the patients were divided into the single infection group and the mixed infection group.After single factor chi square test,multivariate logistic regression model was used to screen the risk factors of mixed infection in the two groups. Results A total of 882 patients were collected,and 1075 pathogens were detected,including 350 strains of Gram-positive bacteria (32.56%),622 strains of Gram-negative bacteria (57.86%),85 strains of Candida (7.91%),and 18 strains of anaerobic bacteria (1.67%),the top five pathogens were mainly Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus,Enterococcus and Candida.There were 700 cases of single infection (79.37%) and 182 cases (20.63%) of mixed infection,the mixed infections were mainly caused by Escherichia coli + Enterococcus and combined infection of Escherichia coli + Klebsiella pneumoniae.Compared with the single infection group,the mixed infection group multi-drug resistant bacteria (MDRO),methicillin-resistant Staphylococcus aureus (MRSA),methicillin-resistant coagulase-negative staphylococcus (MRCNS),and vancomycin-resistant enterococci (CRE),ESBLs-producing Escherichia coli,ESBLs-producing Klebsiella pneumoniae,carbapenem-resistant Acinetobacter baumannii detection rate significantly increased,and the hospitalization time of patients in the mixed infection group ( P <0.05) was significantly prolonged,and the mortality rate( P <0.05) was significantly increased.Multivariate results showed that the advanced age,malignant tumors,multiple organ failure,underlying diseases ≥2 types,invasive treatment,recent hospitalization for more than 7 days,and multidrug resistant bacterial infections were the independent influencing factors of sterile body fluid mixed infections ( P <0.05).Conclusion There are many types of pathogenic bacteria isolated from sterile body fluids of general surgery patients,and the situation of drug resistance is severe.There are many factors affecting general surgery mixed infections.According to the monitoring results,the targeted intervention measures can reduce the incidence of mixed infections,shorten the length of hospital stay,and reduce the mortality.