重症监护室医院下呼吸道感染常见非发酵菌的耐药性与危险因素
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袁天柱

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R563.1

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Drug resistance and risk factors of nonfermentative bacterial healthcareassociated lower respiratory tract infection in an intensive care unit
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    摘要:

    目的探讨某院重症监护室(ICU)3种常见非发酵菌医院获得性下呼吸道感染的耐药性及多重耐药非发酵菌下呼吸道感染的危险因素。方法对该院2009年1月—2010年12月ICU患者下呼吸道分离的182株3种常见非发酵菌分布及耐药情况进行分析;Logistic回归分析其中91例多重耐药菌医院获得性下呼吸道感染的危险因素。结果ICU下呼吸道感染最常见的3种非发酵菌分别是铜绿假单胞菌(41.36%,79/191)、鲍曼不动杆菌(40.32%,77/191)及嗜麦芽窄食单胞菌(13.62%,26/191)。鲍曼不动杆菌对第三、四代头孢菌素及喹诺酮类、氨基糖苷类药物耐药率达80%以上;铜绿假单胞菌对亚胺培南的耐药率在35%以上,对头孢曲松、头孢噻肟的耐药率达70%以上;嗜麦芽窄食单胞菌对复方磺胺甲口恶唑的耐药率,2010年(66.67%)与2009年(7.14%)相比,显著上升(χ2=7.66,P=0.00),并出现了耐米诺环素菌株(8.33%)。医院感染持续时间>2周 (OR=4.53,P=0.03)、联合用药时间>72 h(OR =3.51,P=0.03)是独立的ICU多重耐药非发酵菌医院获得性下呼吸道感染危险因素。结论非发酵菌为ICU医院获得性下呼吸道感染的重要病原菌,耐药严重。严格把握入住ICU临床标准,针对有意义的危险因素采取相应措施预防与控制医院感染的发生,严格控制抗菌药物使用指征等对防止下呼吸道多重耐药非发酵菌感染非常重要。

    Abstract:

    ObjectiveTo evaluate the drug resistance of three common nonfermentative bacterial healthcareassociated lower respiratory tract (LRT) infection in an intensive care unit(ICU), and risk factors of multidrug resistant (MDR) nonfermentative bacterial infection.MethodsDistribution and drug resistance of 182 nonfermentative isolates causing LRT in ICU patients from January, 2009 to December, 2010 were analyzed; risk factors for 91 cases infected with MDR nonfermentative bacteria were analyzed by Logistic regression analysis.ResultsThe three most common nonfermentative bacteria were Pseudomonas aeruginosa (41.36%,79/191), Acinetobacter baumannii (40.32%,77/191), and Stenotrophomonas maltophilia (13.62%,26/191); drugresistant rate of Acinetobacter baumannii to the third and fourth generation cephalosporins, quinolones, and aminoglycosides were up to above 80%; drugresistant rate of Pseudomonas aeruginosa to imipenem was above 35%, to ceftriaxone and cefotaxime was up to more than 70%; drugresistant rate of Stenotrophomonas maltophilia to trimethoprim/sulfamethoxazole increased from 7.14% in 2009 to 66.67% in 2010(χ2=7.66,P=0.00), resistant rate to minocycline was 8.33%. Duration of healthcareassociated infection (HAI) >2 weeks(OR=4.53, P=0.03), drug combination use >72 hours (OR=3.51, P=0.03) were independent risk factors for MDR nonfermentative bacterial healthcareassociated LRT infection (OR=3.51, P=0.03).ConclusionNonfermentative bacteria is the important pathogen in healthcareassociated LRT infection in ICU, with high rate of drug resistance. It is important to prevent MDR nonfermentative bacterial LRT infection by strict limitation on the indication of ICU admission, proper measures according to risk factors, and strict control of antimicrobial agents.

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贾育红,袁天柱,刘滨.重症监护室医院下呼吸道感染常见非发酵菌的耐药性与危险因素[J]. 中国感染控制杂志,2012,11(2):104-108.
JIA Yuhong, YUAN Tianzhu, LIU Bin. Drug resistance and risk factors of nonfermentative bacterial healthcareassociated lower respiratory tract infection in an intensive care unit[J]. Chin J Infect Control, 2012,11(2):104-108.

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  • 收稿日期:2011-11-02
  • 最后修改日期:2012-01-10
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  • 在线发布日期: 2012-03-31
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