脑出血术后合并VAP患者肺多重耐药菌感染的危险因素分析

Risk factors analysis of mutliple drug-resistant organism infection in patients with ventilator-associated pneumonia after operation of cerebral hemorrhage

目的分析脑出血术后合并呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者发生肺部多重耐药菌(multiple drug-resistant organism,MDRO)感染的危险因素及病原学特点。方法回顾性分析2020年1月至2022年1月于安徽医科大学附属省立医院神经重症科收治的103例脑出血术后合并VAP患者。收集患者的年龄、性别、总住院时间、基础疾病、术前格拉斯哥昏迷评分(Glasgow coma score,GCS)、手术类型、手术时间等资料。根据病原菌是否为MDRO将患者分为MDRO感染组(n=42)与非MDRO感染组(n=61)。采用二项Logistic回归分析探讨MDRO感染的相关危险因素。结果Logistic回归分析结果表明,总住院时间、二次手术为MDRO的独立危险因素(P<0.05)。在103例患者的痰培养标本中,检出并统计病原菌103株,其中MDRO 42株(40.78%),包含鲍曼不动杆菌17株(40.48%)、金黄色葡萄球菌11株(26.20%)、铜绿假单胞菌5株(11.90%)、洋葱伯克霍尔德菌4株(9.52%)、肺炎克雷伯杆菌3株(7.14%)、肺炎链球菌1株(2.38%)、阴沟肠杆菌复合菌1株(2.38%)。结论脑出血术后合并VAP患者的总住院时间越长,MDRO感染的风险越高。二次手术患者的MDRO风险显著高于未做二次手术的患者。鲍曼不动杆菌等是常见的MDRO。

Objective To analyze the risk factors and etiological characteristics of pulmonary multiple drug-resistant organism(MDRO)infection and ventilator-associated pneumonia(VAP)in patients with after operation of cerebral hemorrhage.Methods A retrospective analysis was conducted on 103 patients with VAP after operation of cerebral hemorrhage admitted to the Department of Neurointensive Care Unit,Provincial Hospital of Anhui Medical University from January 2020 to January 2022.The clinical baseline data of the patients,including age,gender,total length of stay,underlying diseases,pre-operative Glasgow coma score(GCS),surgery type,surgery time,etc,were collected.The patients were divided into MDRO infection group(n=42)and non MDRO infection group(n=61)according to the pathogenic bacteria for MDRO.Related risk factors of MDRO infection was analyzed by using binary Logistic regression.Results Logistic regression analysis showed that total length of stay and secondary surgery were independent risk factors for MDRO infection(P<0.05).Among the 103 patients with sputum culture specimens,103 strains of pathogenic bacteria were detected and counted,including 42 MDRO(40.78%),including 17 strains of Acinetobacter baumannii(40.48%),11 strains of Staphylococcus aureus(26.20%),5 strains of Pseudomonas aeruginosa(11.90%),4 strains of Burkholderia cepacia(9.52%),3 strains of Klebsiella pneumoniae(7.14%),1 strain of Streptococcus pneumoniae(2.38%),and 1 strain of Enterobacter cloacae complex(2.38%).Conclusion The longer the total length of stay in patients with VAP after operation of cerebral hemorrhage,the higher the risk of MDRO infection is significantly.The risk of MDRO in patients with secondary surgery is significantly higher than that in patients without secondary surgery.Acinetobacter baumannii etc are common MDRO.