摘要
目的分析重症监护病房(ICU)患者医院获得性复数菌血流感染(Nosocomial blood stream infection,NBSI)的影响因素。方法回顾性分析2013年1月-2019年6月贵州医科大学第三附属医院ICU发生医院获得性血流感染648例患者的临床资料,根据血培养是否分离出复数菌分为复数菌血流感染组96例与非复数菌血流感染组552例,分析感染病原菌分布,对两组相关病史特点与实验室检查指标进行比较,归纳影响ICU患者复数菌血流感染的影响因素。结果ICU医院获得性复数菌血流感染率为14.81%(96/648);共检出病菌753株,复数菌血流感染201株,非复数菌血流感染552株,复数菌NBSI分离出的真菌构成比较高(P<0.05),在革兰阳性菌中复数菌NBSI患者分离出的金黄色葡萄球菌较多(P<0.05),在革兰阴性菌中复数菌NBSI患者中分离的病原菌以铜绿假单胞菌与鲍氏不动杆菌占比较多(P<0.05);APACHEⅡ评分、侵入性诊疗、使用糖皮质激素、更换抗菌药物次数、糖化血红蛋白是ICU患者医院获得性复数菌血流感染的影响因素(P<0.05)。结论关注重症患者救治,减少不必要入住ICU时间与侵入性治疗,限制不合理使用糖皮质激素,早期进行药敏试验,合理选用有效抗菌药物,减少盲目频繁更换抗菌药物是减少ICU医院获得性复数菌血流感染主要措施。
OBJECTIVE To analyze the influencing factors of nosocomial plural bacterial bloodstream infection in intensive care unit(ICU).METHODS The clinical data of 648patients with hospital acquired bloodstream infection in ICU of the Third Affiliated Hospital of Guizhou Medical University from January 2013to June 2019were retrospectively analyzed.According to whether the plural bacteria were isolated from blood culture or not,the patients were divided into plural bacteria bloodstream infection group(n=96)and non-plural bacteria bloodstream infection group(n=552).The history characteristics and laboratory examination indexes of the two groups were compared,and the influencing factors of blood flow infection of plural bacteria in ICU patients were summarized.RESULTSThe nosocomial infection rate in ICU was 14.81%(96/648).A total of 753strains of bacteria were detected,including 201strains of plural bacteria and 552strains of non-plural bacteria.The composition of fungi isolated from plural bacteria NBSI was significantly higher than that from non-plural bacteria(P<0.05).Among the Gram-positive bacteria,there were more Staphylococcus aureus isolated from the patients with plural bacteria NBSI(P<0.05).Pseudomonas aeruginosa and Acinetobacter baumannii accounted for the majority of bacteria isolated from NBSI patients infected with Gram-negative bacteria(P<0.05);APACHE II score,invasive diagnosis and treatment,use of glucocorticoids,replacement of antibiotic and glycosylated hemoglobin were the influencing factors of hospital acquired plural bacterial bloodstream infection in ICU patients(P<0.05).CONLUTIONPaying attention to the treatment of severe patients,reducing the time of unnecessary stay in ICU and invasive treatment,restricting the unreasonable use of glucocorticoids,carrying out the drug sensitivity test in the early stage,and rational selection of effective antibiotics,and reducing blindly frequency and more antibiotics are the main measures to reduce the hospital acquired plural bacterial bloodstream infection in ICU.
作者
谢朝云
蒙桂鸾
熊芸
李耀福
杨怀
杨忠玲
XIE Zhao-yun;MENG Gui-luan;XIONG Yun;LI Yao-fu;YANG Huai;YANG Zhong-ling(The Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第20期3082-3086,共5页
Chinese Journal of Nosocomiology
基金
贵州省科技厅联合基金资助项目(黔科合LH字[2014]7162号)
贵州省黔南州社会发展科技基金资助项目(黔南科合社字[2018]7号)
关键词
重症监护病房
医院获得性血流感染
复数菌
影响因素
Intensive care unit
Hospital acquired blood flow infection
Plural bacteria
Influencing factors
