摘要
目的分析重症监护室(ICU)多药耐药菌感染影响因素及其耐药基因。方法选取2017年1月—2019年1月江南大学附属医院治疗的发生耐药菌感染的ICU医院感染患者158例,分为多药耐药菌感染组89例和非多药耐药菌感染组69例。比较患者临床资料、病原菌分布及耐药性。分析发生多重感染的影响因素。筛查多药耐药菌株的耐药基因。结果所有样本种类中痰液居首位,占51.42%,共分离212株病原菌,革兰阴性菌最多108株(50.94%)。共分离出101株多药耐药菌,分离率为47.64%,其中革兰阴性菌65株(64.36%)对头孢类抗菌药物耐药性最强,革兰阳性菌36株(35.64%)对红霉素耐药性最强。Logistic回归分析显示,入住ICU、抗菌药物种类、导尿管滞留时间、深静脉置管时间和凝血时间延长是多药耐药发生的危险因素。多药耐药菌mecA、CTM-M-9、SHV、aac(6′)-II、TEM和aac(3′)-I检出率均高于非多药耐药菌(P<0.05)。结论ICU医院感染患者多药耐药菌分离率为47.64%,携带多种耐药基因,临床应重视合并入住ICU时间长、抗菌药物种类、导尿管滞留时间长和深静脉置管时间长的患者。
OBJECTIVE To investigate the influencing factors for multidrug-resistant organisms(MDROs)infections in ICU patients and observe the drug resistance genes.METHODS A total of 158 patients with nosocomial infection of drug-resistant bacteria infection admitted to IUC of Affiliated Hospital of Jiangnan University from Jan.2017 to Jan.2019 were selected and divided into a multidrug-resistant bacteria infection group of 89 cases and a non-multidrug-resistant bacteria infection group of 69 cases.The clinical data,distribution of pathogens and drug resistance of patients were compared.The influencing factors of multiple infection were analyzed.The resistance genes of multi-drug resistant strains were screened out.RESULTS Among all sample types,sputum ranked first place,accounting for 51.42%.A total of 212 strains of pathogens were isolated,including 108 strains of Gram-negative bacteria(50.94%).A total of 101 strains of multidrug-resistant bacteria were isolated,with an isolation rate of 47.64%.Among them,65 strains(64.36%)of gram-negative bacteria were the most resistant to cephalosporin antibiotics,while 36 strains(35.64%)of gram-positive bacteria were resistant to erythromycin.Logistic regression analysis showed that ICU admission,types of antibacterial drugs,catheter retention time,deep venous catheterization time and prolonged coagulation time were independent risk factors of multidrug resistance.The detection rates of mecA,CTM-M-9,SHV,aac(6′)-II,TEM and aac(3′)-I in multidrug-resistant bacteria infection group were significantly higher than those in non-multidrug-resistant bacteria infection group(P<0.05).CONCLUSION The isolation rate of multidrug resistant bacteria in ICU patients with nosocomial infection is 47.64%,carrying multiple drug-resistant genes.Clinically,attentions should be paid to patients with long stay time in ICU,many types of antibacterial drugs,long catheter indwelling time,deep vein catheterization time and clotting time.
作者
邹丽婷
胡怡倩
卞雯
朱娜
鲍骏
ZOU Li-ting;HU Yi-qian;BIAN Wen;ZHU Na;BAO Jun(Affiliated Hospitalof Jiangnan University,Wuri,Jiangsu 214000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第11期1622-1626,共5页
Chinese Journal of Nosocomiology
基金
无锡市科学技术局科技发展资金资助项目(N20202019)。
关键词
病原菌
多药耐药菌
耐药基因
重症监护室
影响因素
医院感染
Pathogen
Multidrug-resistant bacteria
Drug resistance gene
Intensive care unit
Influencing factor
Nosocomial infection
