重症监护病房MRSA感染的危险因素
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黄志坚

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R181.3+2

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惠州市科技计划项目(20150809)


Risk factors for methicillinresistant Staphylococcus aureus infection in intensive care unit
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    摘要:

    目的了解患者入住重症监护病房(ICU)MRSA感染的危险因素。方法选取2014—2016年某三级综合性医院ICU患者825例,采用病例对照研究,病例组为入住ICU 48 h后MRSA感染者,对照组为入住ICU 48 h后无MRSA感染者,进行单因素和多因素logistic分析。结果825例患者中,64例患者发生了MRSA感染,感染率为7.76%。MRSA感染以肺部感染居多(占45.31%),其次为皮肤软组织感染(18.75%)、手术部位切口感染和血流感染(各占9.38%)、颅内感染和腹腔感染(各占6.25%)、胸腔感染(4.68%)。多因素logistic回归分析结果显示,一个月内接受过手术(OR 95%CI:2.628~9.166)、外伤(OR 95%CI:2.248~9.280)、气管插管时长>7 d(OR 95%CI:1.651~11.746)、昏迷(OR 95%CI:1.813~8.334)、长期卧床(OR 95%CI:1.362~10.127)、再次入住ICU(OR 95%CI:1.475~7.915)、肠外营养(OR 95%CI:1.521~7.518)、使用两联及以上抗菌药物(OR 95%CI:1.523~6.132)、多器官功能衰竭(OR 95%CI:1.024~3.948)是 ICU患者MRSA感染的独立危险因素(均P<0.05)。结论预防与控制ICU MRSA的产生与传播,应严格执行接触隔离措施,重点关注气管插管、多器官功能衰竭、昏迷、长期卧床、外伤等高危人群MRSA的防控,在患者达到条件的情况下应尽快转出ICU。

    Abstract:

    ObjectiveTo understand the risk factors for methicillinresistant Staphylococcus aureus (MRSA) infection in intensive care unit(ICU) patients. Methods825 ICU patients in a tertiary general hospital from 2014 to 2016 were selected, a casecontrol study was conducted, patients infected with MRSA 48 hours after ICU admission were in case group, and those without MRSA infection 48 hours after ICU admission were in control group, univariate and multivariate logistic analysis were conducted.ResultsAmong 825 patients, 64(7.76%) had MRSA infection. The major MRSA infection was pulmonary infection(45.31%), followed by skin and soft tissue infection (18.75%), surgical site infection(9.38%), bloodstream infection (9.38%), intracranial infection(6.25%), abdominal infection (6.25%), and thoracic infection (4.68%). Multivariate logistic regression analysis showed that independent risk factors for MRSA infection in ICU patients were surgery within a month (OR95%CI:2.628-9.166), trauma (OR95%CI:2.248-9.280), duration of tracheal intubation>7 days (OR95%CI:1.651-11.746), coma (OR95%CI:1.813-8.334), longterm bedridden (OR95%CI:1.362-10.127), readmission to ICU (OR95%CI:1.475-7.915), parenteral nutrition (OR95%CI:1.521-7.518), use two or more antimicrobial agents (OR95%CI:1.523-6.132), and multiple organ failure (OR95%CI:1.024-3.948)(all P<0.05).ConclusionPrevention and control of MRSA in highrisk patients such as tracheal intubation, multiple organ failure, coma, longterm bedridden, and trauma should be paid attention, patients should be transferred out of ICU as soon as possible if their condition is permitted.

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黄志坚,倪玉娥,唐炳娣.重症监护病房MRSA感染的危险因素[J]. 中国感染控制杂志,2018,17(12):1103-1106. DOI:10.3969/j. issn.1671-9638.2018.12.015.
HUANG Zhijian, NI Yue, TANG Bingdi. Risk factors for methicillinresistant Staphylococcus aureus infection in intensive care unit[J]. Chin J Infect Control, 2018,17(12):1103-1106. DOI:10.3969/j. issn.1671-9638.2018.12.015.

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  • 收稿日期:2017-12-20
  • 最后修改日期:2018-03-02
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  • 在线发布日期: 2018-12-28
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