老年肺部感染住院患者多药耐药菌感染影响因素的回顾性调查
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摘要
目的探讨引起老年肺部感染住院患者发生多药耐药菌(MDRO)感染影响因素,为老年肺部感染住院患者MDRO的防治提供参考。方法收集2016年1月-2017年12月期间住院的223例老年肺部感染患者临床资料,调查患者一般资料及肺部感染发生情况,对感染患者MDRO检测结果进行分析。结果共检出感染病原菌238株,其中87例为MDRO感染,感染率为39.01%,检出MDRO 92株,占总菌株的38.66%;MDRO中革兰阴性菌占72.83%,革兰阳性菌占27.17%,主要感染病原菌为铜绿假单胞菌、金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌;患者年龄≥80岁、住院天数≥2周、合并心血管疾病、留置导尿管、机械通气、动静脉置管、抗菌药物使用种类≥2种、抗菌药物使用时间≥2周时MDRO感染率较高(P<0.05);Logistic回归分析结果显示住院时间长、合并心血管疾病、留置导尿管、机械通气、动静脉置管、抗菌药物使用种类≥2种、抗菌药物使用时间≥2周是老年肺部感染患者发生MDRO感染的独立影响因素(P<0.05)。结论老年肺部感染住院患者MDRO感染率较高,引起MDRO感染的影响因素较多,应根据相关危险因素积极进行预防以降低MDRO感染。
OBJECTIVE To explore the influencing factors for the multidrug-resistant organisms(MDROs)infections in elderly hospitalized patients with pulmonary infections so as to provide guidance for prevention and treatment of the elderly patients with MDROs infections.METHODS The clinical data were collected from 223 elderly patients with pulmonary infections who were hospitalized from Jan 2016 to Dec 2017,the baseline data of the patients and incidence of pulmonary infections were investigated,and the result of MDROs test was observed.RESULTS A total of 238 strains of pathogens were isolated,and 87 patients had MDROs infections,with the infection rate 39.01%.Totally 92 strains of MDROs were detected,accounting for 38.66%,72.83% of which were gram-negative bacteria,and 27.17% were gram-positive bacteria.Pseudomonas aeruginosa,Staphylococcus aureus,Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli were the predominant species of pathogens causing the infections.The incidence of MDROs infections was significantly high in the patients with no less than 80 years of age,length of hospital stay no less than 2 weeks,complication with cardiovascular disease,urinary catheter indwelling,mechanical ventilation,arteriovenous intubation,use of no less than 2 types of antibiotics and time of use of antibiotics no less than 2 weeks(P <0.05).The result of logistic regression analysis showed that the long length of hospital stay,complication with cardiovascular disease,urinary catheter indwelling,mechanical ventilation,arteriovenous intubation,use of no less than 2 types of antibiotics and time of use of antibiotics no less than 2 weeks were the independent influencing factors for the MDROs infections in the elderly patients with pulmonary infections(P<0.05).CONCLUSION The incidence of MDROs infections is high among the elderly hospitalized patients with pulmonary infections,and there are a variety of influencing factors for the MDROs infections,and it is necessary to take the prevention measures according to the related risk factors so as to reduce the incidence of MDROs infections.
OBJECTIVE To explore the influencing factors for the multidrug-resistant organisms(MDROs)infections in elderly hospitalized patients with pulmonary infections so as to provide guidance for prevention and treatment of the elderly patients with MDROs infections.METHODS The clinical data were collected from 223 elderly patients with pulmonary infections who were hospitalized from Jan 2016 to Dec 2017,the baseline data of the patients and incidence of pulmonary infections were investigated,and the result of MDROs test was observed.RESULTS A total of 238 strains of pathogens were isolated,and 87 patients had MDROs infections,with the infection rate 39.01%.Totally 92 strains of MDROs were detected,accounting for 38.66%,72.83% of which were gram-negative bacteria,and 27.17% were gram-positive bacteria.Pseudomonas aeruginosa,Staphylococcus aureus,Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli were the predominant species of pathogens causing the infections.The incidence of MDROs infections was significantly high in the patients with no less than 80 years of age,length of hospital stay no less than 2 weeks,complication with cardiovascular disease,urinary catheter indwelling,mechanical ventilation,arteriovenous intubation,use of no less than 2 types of antibiotics and time of use of antibiotics no less than 2 weeks(P <0.05).The result of logistic regression analysis showed that the long length of hospital stay,complication with cardiovascular disease,urinary catheter indwelling,mechanical ventilation,arteriovenous intubation,use of no less than 2 types of antibiotics and time of use of antibiotics no less than 2 weeks were the independent influencing factors for the MDROs infections in the elderly patients with pulmonary infections(P<0.05).CONCLUSION The incidence of MDROs infections is high among the elderly hospitalized patients with pulmonary infections,and there are a variety of influencing factors for the MDROs infections,and it is necessary to take the prevention measures according to the related risk factors so as to reduce the incidence of MDROs infections.
引文
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[12]薛燕,仲骏,王秀雯,等.心脏外科ICU患者多重耐药菌感染情况及预后危险因素分析[J].齐鲁护理杂志,2017,23(20):44-47.
[13]林佩贤,黄宝添,许斐斐,等.重症监护室多重耐药菌医院感染临床特点与耐药性分析[J].国际流行病学传染病学杂志,2015,42(4):228-231.
[14]杨羚,廖海涛,韦义萍.ICU中心静脉导管相关血行感染的病原菌及耐药性分析[J].内科,2013,8(6):577-579.
[2]MDR、XDR、PDR多重耐药菌暂行标准定义--国际专家建议[J].中国感染控制杂志,2014,13(1):62-64.
[3]Neumann N,Mischler D,Cuny C,et al.Multidrug-resistant organisms(MDRO)in patients in outpatient care in the Rhine-Main region,Germany,in 2014:prevalence and risk factors[J].Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2016,59(2):292-300.
[4]Heudorf U,Farber D,Mischler D,et al.Multidrug-resistant organisms(MDRO)in rehabilitation clinics in the RhineMain-district,Germany,2014:prevalence and risk factors[J].Rehabilitation(Stuttg),2015,54(5):339-345.
[5]Abad CLR,Lahr BD,Razonable RR.Epidemiology and risk factors for infection after living donor liver transplantation[J].Liver Transpl,2017,23(4):465-477.
[6]林秀娟,林红燕,钟韵.某三甲医院2014-2016年多重耐药菌感染趋势变迁[J].广东医学,2018,39(1):107-110.
[7]Kahvecioglu D,Ramiah K,McMaughan D,et al.Multidrugresistant organism infections in US nursing homes:a national study of prevalence,onset,and transmission across care settings,October 1,2010-December 31,2011[J].Infect Control Hosp Epidemiol,2014,35,(Suppl 3):S48-S55.
[8]Crum-Cianflone NF,Sullivan E,Ballon-Landa G.Fecal microbiota transplantation and successful resolution of multidrugresistant-organism colonization[J].J Clin Microbiol,2015,53(6):1986-1989.
[9]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].中华结核和呼吸杂志,1999,22(4):201-203.
[10]Clinical and laboratory standards insitute.Performance Standards for Antimicrobial Susceptibility Testing:Twenty-Fifth Informational Supplement(M100-S25)[S].Wayne,PA 19087USA,2015.
[11]Mehrad B,Clark NM,Zhanel GG,et al.Antimicrobial resistance in hospital-acquired gram-negative bacterial infections[J].Chest,2015,147(5):1413-1421.
[12]薛燕,仲骏,王秀雯,等.心脏外科ICU患者多重耐药菌感染情况及预后危险因素分析[J].齐鲁护理杂志,2017,23(20):44-47.
[13]林佩贤,黄宝添,许斐斐,等.重症监护室多重耐药菌医院感染临床特点与耐药性分析[J].国际流行病学传染病学杂志,2015,42(4):228-231.
[14]杨羚,廖海涛,韦义萍.ICU中心静脉导管相关血行感染的病原菌及耐药性分析[J].内科,2013,8(6):577-579.
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