神经内科颅内感染性疾病患者多重耐药菌感染危险因素分析

Analysis of risk factors in intracranial infectious patients with multi-drug resistant bacteria infection in neurology department

目的:探讨颅内感染性疾病患者发生多重耐药菌(multi-drug resistant bacteria,MDRO)感染的病原菌特点及其危险因素,为临床MDRO感染的防治提供理论参考。方法:选取2020年9月至2022年9月中国人民解放军总医院第一医学中心神经内科收治的153例颅内感染性疾病患者作为研究对象,根据患者是否发生MDRO感染将其分为MDRO感染组(15例)和非MDRO感染组(138例),采用单因素检验和logistic回归分析法对颅内感染性疾病患者发生MDRO感染的相关危险因素进行分析。结果:单因素检验显示,年龄、是否合并低白蛋白血症或糖尿病等基础疾病、住院天数、抗生素使用天数、是否有侵入性操作等因素与MDRO感染相关(P<0.05);多因素logistic回归结果显示,年龄、合并低白蛋白血症或糖尿病、住院天数、抗生素使用天数、有侵入性操作等因素是神经内科颅内感染性疾病患者感染MDRO的独立危险因素。15例发生MDRO感染的患者中共分离出MDRO 58株,大部分(53.4%)为革兰阴性菌,其中鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌分别占9.0%、17.2%、10.4%。结论:神经内科颅内感染性疾病患者MDRO感染的发生率较高,为9.8%;年龄、是否合并低白蛋白血症或糖尿病等基础疾病、住院天数、抗生素使用天数、是否有侵入性操作等因素与MDRO感染的发生密切相关;鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌等革兰阴性菌为颅内感染性疾病患者发生MDRO感染的主要致病菌,对于有高危风险的患者,临床上应高度重视,并采取必要的管理措施,以减少MDRO感染的发生。

OBJECTIVE To explore the pathogenic characteristics and risk factors of multi-drug resistant bacteria(MDRO)infection in patients with intracranial infectious diseases and provide references for clinical prevention and treatment of MDRO.METHODS According to the occurrence of MDRO infections,from September 2020 to September 2022,153 patients with intracranial infectious diseases were assigned into two groups of MDRO infection(n=15)and non-MDRO infection(n=138).Single factor test and logistic regression analysis were utilized for exploring the risk factors of MDRO infections.RESULTS Single factor test indicated that age,hypoproteinemia,diabetes mellitus(DM),length of hospitalization,course of antibiotic dosing and invasive operation were associated with MDRO infections(P<0.05).The results of multivariate logistic regression suggested that age,hypoproteinemia,DM,length of hospitalization,course of antibiotic dosing and invasive operation were independent risk factors.Fifty-eight strains of MDRO were isolated from 15 MDRO-infected patients.A great majority(53.4%)were gram-negative bacteria,including Acinetobacter baumannii(19.0%),Klebsiella pneumoniae(17.2%)and Pseudomonas aeruginosa(10.4%).CONCLUSION The incidence of MDRO infection with intracranial infectious diseases at Department of Neurology is 9.8%.Age,basic diseases such as DM or hypoproteinemia,length of hospitalization,course of antibiotic dosing and invasive operation are closely correlated with the occurrence of MDRO infection.A.baumannii,K.pneumoniae and P.aeruginosa are the major pathogens of MDRO infection in patients with intracranial infectious diseases.For high-risk patients,clinicians take some important measures to lower the incidence of MDRO infection.