重症监护室患者医院获得性感染特点、耐药性及危险因素分析

Analysis of characteristics,drug resistance and risk factors of hospital acquired infection in intensive care unit patients

目的 分析医院获得性感染(hospital-acquired infection, HAI)特点、耐药性及危险因素,为有效防治HAI提供临床依据。方法 选取2017年1月1日至12月31日某市级三级甲等医院重症医学科、呼吸内科、急诊科、神经外科监护室患者伴HAI 446例为观察组,选择同期入院、相同性别、科室、基础疾病及年龄相差5岁以内的未发生HAI感染的患者446例为对照组。分析HAI的危险因素、病原菌种类和分布特点、耐药性。结果 HAI的发病率为0.74%,病死率为19.28%。侵入性操作、进行手术、器官损伤累及数和血清白蛋白水平为HAI的独立危险因素。病原菌标本来源主要是痰液,构成比为70.00%以上,其他来源为尿液、血液和浆膜腔积液等。446例HAI患者共检出502株病原菌,前5位病原菌依次为鲍曼不动杆菌、肺炎克雷伯菌、白色假丝酵母菌、铜绿假单胞菌和金黄色葡萄球菌。鲍曼不动杆菌对多种常用抗生素耐药率高达70.00%以上,肺炎克雷伯菌对三、四代头孢菌素和哌拉西林的耐药率达50.00%以上,铜绿假单胞杆菌对磺胺类耐药率达50.00%以上,金黄色葡萄球菌对青霉素类抗生素耐药率达100.00%。结论 HAI易发生于侵入性操作、进行手术、器官损伤累及数≥2个、血清白蛋白水平<35 g/L的患者。HAI发生率与病死率高,前5位病原菌广泛耐药。

Objective To analyze the characteristics, drug resistance and risk factors of hospital acquired infection(HAI) so as to provide clinical evidence for effective prevention and treatment of HAI.Methods A total of 446 patients with HAI received by the intensive care department, respiratory department, emergency department, and neurosurgical care unit of a Grade A tertiary hospital from January 1 to December 31,2017 were enrolled as the observed group.A total of 446 HAI patients who were admitted to hospital at the same time period, with the same sex, in the same departments, with similar underlying disease and with an age difference of less than 5 years were selected as the control group.The risk factors, pathogen species and distribution characteristics, drug resistance of HAI were analyzed.Results The incidence of HAI was 0.74% and the case fatality rate was 19.28%.Invasive operations, surgeries, the number of organ injuries involved and the serum albumin level were independent risk factors for HAI.The main source of the pathogen was sputum, with a composition ratio of above 70.00%.Other sources were urine, blood and serous effusion.A total of 502 pathogenic bacteria were detected in 446 patients with HAI.The top 5 pathogens were Acinetobacter baumannii,Klebsiella pneumoniae,Candida albicans,Pseudomonas aeruginosa,and Staphylococcus aureus.The resistance rate of Acinetobacter baumannii to several commonly used antibiotics was over 70.00%.The resistance rate of Klebsiella pneumoniae to the third generation and fourth generation cephalosporins and piperacillin was above 50.00%.The resistance rate of Pseudomonas aeruginosa to sulfonamides was more than 50.00%,and Staphylococcus aureus was 100.00% resistant to penicillin antibiotics.Conclusion HAI is most likely to occur in patients with invasive procedures, surgeries, a organ damage involvement ≥2,and a serum albumin level <35 g/L.The incidence and mortality of HAI were high, and the top 5 pathogens were extensively resistant to the drugs.