基于主动筛查的ICU患者多重耐药菌感染/定植的影响因素分析

赵雪; 刘国媚; 张文惠; 万小川; 王文斌; 吴贻乐

doi:10.16766/j.cnki.issn.1674-4152.002887

基于主动筛查的ICU患者多重耐药菌感染/定植的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002887

1.
安徽医科大学第四附属医院科研部，安徽合肥 230012
2.
安徽医科大学第四附属医院医院感染管理办公室，安徽合肥 230012
3.
安徽医科大学第二附属医院医院感染管理办公室, 安徽合肥 230601

基金项目:

国家自然科学基金项目 82202572

安徽省高校自然科学研究项目 KJ2021A0332

安徽省高校自然科学研究项目 KJ2021A0321

安徽医科大学校基金资助项目 2020xkj042

详细信息

通讯作者:
吴贻乐, E-mail: wuyilebank@163.com

中图分类号: R372
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- 被引次数: 0
出版历程
- 收稿日期: 2022-05-09
- 网络出版日期: 2023-04-19

Influencing factors of infection or colonization with multidrug-resistant organisms in ICU based on active screening

1.
Department of Scientific Research, the Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230012, China

摘要

摘要: 目的探讨重症监护病房(ICU)患者多重耐药菌(MDROs)医院感染/定植发生情况及影响因素，为制定MDROs防控措施提供科学的依据。方法选取2019年7月—2021年6月入住安徽医科大学第四附属医院ICU患者(466例)为研究对象，采用主动筛查和常规送检的方式监测MDROs医院感染/定植的发生。运用多因素logistic回归分析研究MDROs医院感染/定植的影响因素。结果 466例ICU患者中发生MDROs医院感染/定植共161例(34.55%)，其中MDROs感染41例(8.80%), MDROs定植120例(25.75%)。多因素logistic回归分析显示，ICU住院时间超过7 d、急性生理学及慢性健康状况评分Ⅱ(APACHE Ⅱ)评分高、有创机械通气、联用抗菌药物超过3种、应用激素以及同病床的前患者存在MDROs感染/定植为ICU患者发生MDROs医院感染/定植的危险因素(均P < 0.05)。结论 ICU患者MDROs医院感染/定植发生率较高，与多重因素相关，应采取综合性措施降低患者MDROs医院感染/定植率。
- 多重耐药菌 /
- 感染 /
- 定植 /
- 影响因素
Abstract: Objective To investigate the incidence and influencing factors of multidrug-resistant organisms (MDROs) infection or colonization in the intensive care unit (ICU), so as to provide scientific basis for MDROs prevention and control measures. Methods A total of 466 ICU patients admitted to the Fourth Affiliated Hospital of Anhui Medical University from July 2019 to June 2021 were selected as the research objects. The occurrence of MDROs nosocomial infection or colonization was monitored by means of active screening and microbiological cultures according to clinical status. Multivariate logistic regression analysis was performed in examining the influencing factors of MDROs infection or colonization. Results Among 466 ICU inpatients, MDROs nosocomial infection or colonization was detected in 161 cases (34.55%), including 41 cases (8.80%) of MDROs infection and 120 cases (25.75%) of MDROs colonization. Multivariate logistic regression analysis showed that more than 7 days of ICU hospitalization, high acute physiology and chronic health evaluation (APACHE) Ⅱ score, invasive mechanical ventilation, more than 3 kinds of combined antibiotics, steroid use and having a prior bed occupant with MDROs were risk factors for MDROs infection or colonization in ICU inpatients(all P < 0.05). Conclusion ICU inpatients have a high incidence of MDROs nosocomial infection or colonization, which is related to multiple factors. Comprehensive measures should be taken to reduce the incidence of MDROs nosocomial infection or colonization.
- Multidrug-resistant organisms /
- Infection /
- Colonization /
- Influencing factors

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表 1 ICU患者MDROs感染和定植的菌株分布[株(%)]

Table 1. Distribution of MDROs infection and colonization in ICU patients [strain (%)]

病原菌	菌株数	定植菌株数	感染菌株数
ESBLs-EC	36(20.93)	30(22.90)	6(14.63)
ESBLs-KP	27(15.70)	16(12.21)	11(26.83)
CRE	42(24.42)	33(25.19)	9 (21.95)
CRABA	26(15.12)	18(13.74)	8(19.51)
MRSA	31(18.02)	27(20.61)	4(9.76)
CRPAE	10(5.81)	7(5.34)	3(7.32)
VRE	0	0	0

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表 2 ICU患者发生MDROs医院感染/定植的单因素分析

Table 2. Univariate analysis of nosocomial infection/colonization of MDROs in ICU patients

变量	MDROs感染/定植组(n=161)	非MDROs感染/定植组(n=305)	统计量	P值
性别(例)
男性	115	207	0.625^a	0.429
女性	46	98
年龄(x±s，岁)	61.87±14.55	61.30±16.46	0.387^b	0.699
入住ICU时间≥7 d(例)	105	86	59.708^a	＜0.001
APACHE Ⅱ(x±s，分)	23.34±7.92	21.22±7.78	2.788^b	0.006
合并高血压(例)	56	110	0.076^a	0.783
合并糖尿病(例)	20	37	0.008^a	0.927
合并恶性肿瘤(例)	32	47	1.493^a	0.222
留置导尿管(例)	156	289	1.122^a	0.290
深静脉置管(例)	134	230	3.769^a	0.052
有创机械通气(例)	150	226	24.590^a	＜0.001
手术(例)	90	144	3.181^a	0.074
抗菌药物种类≥3种(例)	107	97	51.422^a	＜0.001
应用碳青霉烯类抗菌药物(例)	96	122	16.305^a	＜0.001
抗菌药物使用时间≥7 d(例)	105	88	57.432^a	＜0.001
应用激素(例)	98	77	57.024^a	＜0.001
同病床的前患者存在MDRO感染/定植(例)	85	102	16.426^a	＜0.001
注：^a为χ²值，^b为t值。

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表 3 自变量赋值方法

Table 3. Independent variable assignment methods

变量	赋值方法
入住ICU时间	＜7 d=0，≥7 d=1
APACHE Ⅱ	以实际值赋值
深静脉置管	无=0，有=1
有创机械通气	无=0，有=1
手术	无=0，有=1
抗菌药物种类	＜3种=0，≥3种=1
应用碳青霉烯类抗菌药物	无=0，有=1
抗菌药物使用时间	＜7 d=0，≥7 d=1
应用激素	无=0，有=1
同病床的前患者存在MDRO感染/定植	无=0，有=1

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表 4 ICU患者发生MDROs医院感染/定植的logistic回归分析

Table 4. logistic regression analysis of nosocomial infection/colonization of MDROs in ICU patients

变量	B	SE	Wald χ²	P值	OR值	95% CI
ICU住院时间≥7 d	0.562	0.269	4.359	0.037	1.755	1.035~2.974
APACHE Ⅱ评分	0.034	0.015	5.298	0.021	1.034	1.005~1.064
有创机械通气	1.186	0.377	9.898	0.002	3.273	1.564~6.852
抗菌药物种类≥3种	0.957	0.260	13.532	＜0.001	2.604	1.564~4.336
应用激素	0.991	0.244	16.444	＜0.001	2.694	1.669~4.350
同病床的前患者存在MDRO感染/定植	1.121	0.237	22.346	＜0.001	3.069	1.928~4.885

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