ICU呼吸机相关性肺炎病原菌分布情况及多重耐药菌感染的危险因素调查研究

doi:10.3969/j.issn.1006-6233.2022.07.023

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摘要 目的: 研究重症监护病房(ICU)呼吸机相关性肺炎患者感染病原菌分布情况及多重耐药菌感染的危险因素。方法: 回顾性收集2018年1月至2021年6月我院ICU的150例呼吸机相关性肺炎患者的临床资料,统计患者感染病原菌分布情况,根据患者是否发生多重耐药菌感染将患者分为耐药菌组(93例)和非耐药菌组(57例),统计ICU呼吸机相关性肺炎患者多重耐药菌感染的单因素,采用多因素Logistic回归分析ICU呼吸机相关性肺炎患者多重耐药菌感染的危险因素。结果: 150例ICU呼吸机相关性肺炎患者共分离出病原菌240株,主要为革兰氏阴性菌感染,占比为84.17%,其中占比前三位的病原菌分别为肺炎克雷伯杆菌、鲍曼不动杆菌和铜绿假单胞菌(25.42%、20.42%、12.50%)。150例ICU呼吸机相关性肺炎患者共发生多重耐药菌感染93例,感染率为62.00%。单因素分析结果显示,耐药菌组合并糖尿病、发生意识障碍、发生吞咽功能障碍、呼吸机相关性肺炎类型为晚发型、近90d接受3代头孢菌素、含酶抑制剂复合制剂或碳青霉烯类抗菌药物、呼吸机通气时间≥7d、入住ICU时间≥7d患者占比高于非耐药菌组(P<0.05)。多因素Logistic回归分析结果显示,发生意识障碍、呼吸机相关性肺炎类型为晚发型、近90d接受3代头孢菌素、含酶抑制剂复合制剂或碳青霉烯类抗菌药物、呼吸机通气时间≥7d、入住ICU时间≥7d均为ICU呼吸机相关性肺炎患者多重耐药菌感染的独立危险因素(OR=4.644、3.152、4.289、2.421、17.167,P<0.05)。结论: ICU呼吸机相关性肺炎主要感染病原菌种类为肺炎克雷伯杆菌、鲍曼不动杆菌和铜绿假单胞菌,ICU呼吸机相关性肺炎患者多重耐药菌感染的独立危险因素包括发生意识障碍、呼吸机相关性肺炎类型为晚发型、近90d接受3代头孢菌素、含酶抑制剂复合制剂或碳青霉烯类抗菌药物、呼吸机通气时间≥7d、入住ICU时间≥7d,临床可据此对有以上特征的患者进行针对性干预或治疗,以降低ICU呼吸机相关性肺炎患者多重耐药菌感染的风险。

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关键词 ：呼吸机相关性肺炎, 多重耐药菌, 感染, 重症监护病房, 病原菌, 危险因素

Abstract：Objective: To investigate the distribution of pathogenic bacteria and risk factors of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU. Methods: Clinical data of 150 patients with ventilator-associated pneumonia admitted to our hospital from January 2018 to December 2020 were retrospectively collected, and the distribution of pathogenic bacteria in patients was analyzed. Patients were divided into the drug-resistant bacteria group (93 cases) and the non-drug-resistant bacteria group (57 cases) according to whether multidrug-resistant bacteria infection occurred. The single factor of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia ICU was analyzed, and the risk factors of multiple drug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU were analyzed by multivariate Logistic regression. Results: A total of 240 strains of pathogenic bacteria were isolated from 150 patients with ventilator-associated pneumonia in ICU, mainly gram-negative bacteria, accounting for 84.17%, among which the top three pathogens were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa (25.42%, 20.42%, 12.50%). A total of 93 cases of multidrug-resistant bacteria infection occurred in 150 patients with ventilator-associated pneumonia in ICU, and the infection rate was 62.00%. Univariate analysis showed that the proportion of patients with diabetes mellitus, disturbance of consciousness, dysphagia, late type of stroke associated pneumonia, the treatment of the 3rd and 4th generation cephalosporins as well as complex preparations containing enzyme inhibitors and carbapenems in the past 90 days, time of ventilator ventilation ≥7 d, ICU stay ≥7 d in the drug-resistant bacteria group was higher than that in the non-drug-resistant bacteria group (P<0.05). Multivariate Logistic regression analysis showed that the disturbance of consciousness, late type of stroke associated pneumonia, the treatment of the 3rd and 4th generation cephalosporins as well as complex preparations containing enzyme inhibitors and carbapenems in the past 90 days, time of ventilator ventilation ≥7 d, ICU stay ≥7 d were all independent risk factors for multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU (OR=4.644, 3.152, 4.289, 2.421, 17.167, P<0.05). Conclusion: The main pathogen of ventilator-associated pneumonia in ICU was Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, patients with ventilator-associated pneumonia in ICU correlation independent risk factors for infection multi-resistant bacteria including the occurrence of disturbance of consciousness, late onset of ventilator-associated pneumonia, indent gastric tube, time of ventilator ventilation ≥7 d, and ICU stay ≥7 d. Clinically, targeted intervention or treatment could be carried out for patients with the above characteristics to reduce the risk of multidrug-resistant bacteria infection in patients with ventilator-associated pneumonia in ICU.

Key words： Ventilator-associated pneumonia Multidrug-resistant bacteria Infection Intensive care unit Pathogenic bacteria Risk factors

基金资助:河北省承德市科学技术研究与发展计划项目,(编号:202006A064)

通讯作者: 陈琳光

引用本文:

卜春红, 滑立伟, 付强, 陈琳光, 郑国利. ICU呼吸机相关性肺炎病原菌分布情况及多重耐药菌感染的危险因素调查研究[J]. 河北医学, 2022, 28(7): 1166-1172.
BU Chunhong, HUA Liwei, FU Qiang, et al. A Study on the Distribution of Pathogenic Bacteria and Risk Factors for Multidrug Resistant Bacterial Infections in ICU Ventilator-Associated Pneumonia. HeBei Med, 2022, 28(7): 1166-1172.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.07.023 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I7/1166

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