论文部分内容阅读
目的探索住院患者发生多重耐药菌(MDRO)医院感染肺炎的危险因素。方法对2013年4月1日—12月31日北京、上海、长沙和广西四地区22所三甲医院全部住院患者5种MDRO(分别为MRSA、MDRPA、MDRAB、ESBL KP、ESBL E.coli)及对应敏感菌(MSSA、PA、AB、KP、E.coli)引起的医院感染肺炎患者进行调查(耐药组:发生5种MDRO医院感染肺炎的患者;敏感组:发生对应5种敏感菌医院感染肺炎的患者),分析发生MDRO医院感染肺炎的危险因素,比较耐药组和敏感组患者预后、住院花费和住院时间。结果共1 656例住院患者符合纳入标准,其中43例(2.60%)患者发生耐药菌和敏感菌的混合感染;耐药组927例(55.98%),敏感组772例(46.62%)。采用logistic回归模型进行多因素分析,结果显示,患者入住重症监护室(ICU)史[OR95%CI:1.55(1.14~2.11)]、机械通气史[OR95%CI:1.45(1.15~1.84)]、动静脉置管[OR95%CI:1.29(1.02~1.63)]、进行纤维支气管镜操作[OR95%CI:1.46(1.02~2.09)]、使用抗菌药物[OR95%CI:1.63(1.20~2.22)]、患有慢性肺部疾病[OR95%CI:1.54(1.13~2.10)]和慢性心脑血管疾病[OR95%CI:1.42(1.15~1.74)]是发生MDRO医院感染肺炎的独立危险因素。耐药组患者较敏感组住院时间平均延长5.89 d,住院费用增加40 739.30元,抗感染药物费用增加2 805.80元;耐药组患者预后差于敏感组,死亡风险是后者的1.66倍(OR95%CI:1.16~2.35)。结论入住ICU、进行各种侵入性操作、使用抗菌药物,以及患慢性肺部疾病和心脑血管疾病均会增加患者发生MDRO医院感染肺炎的风险。
Objective To explore the risk factors of hospital-acquired pneumonia in hospitalized patients with multiple drug-resistant bacteria (MDRO). Methods Five MDROs (MRSA, MDRPA, MDRAB, ESBL KP and ESBL E.coli) of all inpatients in 22 top three hospitals in Beijing, Shanghai, Changsha and Guangxi from April 1 to December 31, 2013 and Patients with nosocomial pneumonia caused by sensitive strains (MSSA, PA, AB, KP, and E.coli) were investigated (resistant group: 5 patients with MDRO hospital-acquired pneumonia; sensitive group: nosocomial infections corresponding to 5 susceptible strains Pneumonia patients). The risk factors of pneumonia in MDRO hospital were analyzed. The prognosis, hospitalization cost and hospital stay of patients in resistant group and sensitive group were compared. Results A total of 1 656 hospitalized patients met the inclusion criteria. Among them, 43 (2.60%) patients were infected with drug-resistant and susceptible strains. There were 927 (55.98%) resistant patients and 772 (46.62%) sensitive patients. Multivariate analysis using logistic regression models revealed that patients were admitted to ICU history [OR95% CI: 1.55 (1.14-2.11)], mechanical ventilation history [OR95% CI 1.45 (1.15-1.84)], (OR 95% CI: 1.29 (1.02-1.63)] for bronchoscopy [OR 95% CI: 1.46 (1.02-2.09)] and antimicrobial agents OR95% CI: 1.54 (1.13-2.10)] and chronic cardiovascular and cerebrovascular diseases [OR95% CI: 1.42 (1.15-1.74)] were independent risk factors for developing pneumonia in MDRO hospital. In the drug-resistant group, the average length of hospitalization was 5.89 days in the more sensitive group, the hospitalization cost was increased by 40,739.30 yuan, and the cost of anti-infective drugs was increased by 2,805.80 yuan. The patients in the drug-resistant group had a worse prognosis than the sensitive group with a 1.66-fold risk of death % CI: 1.16 ~ 2.35). CONCLUSIONS: ICU occupancy, invasive procedures, antimicrobial use, and chronic lung disease and cardiovascular and cerebrovascular diseases all increase the risk of developing pneumonia in MDRO patients.