摘要
目的分析呼吸重症监护病房（RICU）患者多重耐药鲍曼不动杆菌（MDR-AB）获得性定植的相关危险因素。方法主动筛查2010年1月至2011年6月110例RICU患者中MDR—AB获得性定植情况，同时监测患者病床周围环境MDR—AB的污染情况。收集MDR-AB获得性定植患者病历资料，采用Logistic回归模型分析患者入住RICU期间发生MDR-AB定植的相关危险因素。结果剔除3例MDR—AB输人性定植病例后，107例患者纳入研究。RICU患者MDR—AB获得性定植率为43．9％（47／107）。共监测103例RICU患者病床周围环境，结果显示MDR—AB定植患者病床周围环境检出率（66．0％，31／47）明显高于未定植患者检出率（33．9％，19／56；x^2=10．494，P〈0．01）。单因素分析筛选MDR．AB获得性定植的相关危险因素有5项，分别是意识障碍、碳青霉烯类抗生素应用、气管插管、鼻饲胃管、机械通气（均P〈0．05）。Logistic回归模型人选危险因素有3项：意识障碍、碳青霉烯类抗生素应用、机械通气（OR=3．412，3．211，3．002；95％CI：1．165～9．992，1．117～9．233，1．101—8．182）。结论意识障碍、碳青霉烯类抗生素应用、机械通气是RICU患者MDR．AB获得性定植的独立危险因素。
Objective To determine the risk factors for respiratory intensive care unit （RICU）- acquired colonization of multidrug-resistant Acinetobacter baumannii （MDR-AB）. Methods From January 2010 to June 2011, active screening was performed to define patients with RICU-acquired colonization of MDR-AB. And environment surveillance was carried out and patient data were collected. Logistic regression was applied to identify the risk factors of RICU-acquired colonization of MDR-AB. Results Active screening for MDR-AB was performed for 110 patients in RICU and 50 patients turned out to be positive. After eliminating 3 input positive patients, the RICU-acquired colonization rate of MDR-AB was 43.9% （ 47/107 ）. The environmental contaminated rate of MDR-AB was 66. 0% （ 31/47 ） for 47 positive patients and 33.9% （19/56） for 56 negative ones （ X2 = 10. 494, P 〈 0. 01 ）. Five risk factors were associated with the colonization of MDR-AB through univariate analysis： consciousness disturbance, use of carbapenems, nasal feeding tube, endotraeheal intubation and mechanical ventilation （all P 〈 O. 05 ）. The Logistic regression equation contained 3 risk factors of conscious disturbance, use of earbapenems and mechanical ventilation（ OR = 3.412, 3.211,3.002; 95% CI： 1.165 - 9.992, 1.117 - 9.233, 1.101 - 8. 182）. Conclusion Three risk factors are independently associated with the RICU-acquired colonization of MDRAB： consciousness disturbance, use of carbapenems and mechanical ventilation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第14期960-963,共4页
National Medical Journal of China
基金
国家自然科学基金（30970126）
关键词
重症监护病房
鲍氏不动杆菌
多重耐药
主动筛查
定植
Intensive care units
Acinetobacter baurnannii
Multidrug resistance
Active screening
Colonization
