目的 调查呼吸重症监护病房(RICU)下呼吸道感染病原菌种类及耐药情况,探索引发多重耐药菌感染的危险因素,为制订预防和控制多重耐药菌感染措施提供参考依据.方法 收集2014年1~12月在无锡市第二人民医院RICU接受治疗的74例痰培养阳性下呼吸道感染病例作为研究对象,对引发下呼吸道感染的病原菌种类及其耐药情况进行调查,统计分析可能导致多重耐药菌感染的危险因素.结果 74例研究对象中分离出161株病原菌,占前4位的病原菌分别为金黄色葡萄球菌(23.60%)、肺炎克雷伯杆菌(20.50%)、鲍曼不动杆菌(16.15%)和铜绿假单胞菌(9.94%).其中多重耐药菌106株(65.84%),主要包括金黄色葡萄球菌(35.85%)、肺炎克雷伯杆菌(22.64%)、鲍曼不动杆菌(14.15%)等;泛耐药菌12株(7.45%),主要为鲍曼不动杆菌(11株)和肺炎克雷伯杆菌(1株).74例病例中有49例(66.22%)感染2种以上病原菌,其中合并耐甲氧西林金黄色葡萄球菌(MRSA)感染31例(41.89%).Logistics回归分析显示,急性生理与慢性健康评分(APACHEⅡ)为多重耐药菌感染的独立危险因素.结论 RICU下呼吸道多重耐药菌感染发生率高,APACHEⅡ评分是多重耐药菌感染的独立危险因素.%Objective To investigate the distribution of pathogens and antimicrobial resistance among patients with lower respiratory tract infections managed in respiratory intensive care unit(RICU),and analyze the risk factors for multi-drug resistant pathogen infections for evidences to control and prevent the drug resis-tance. Methods A total of 74 patients with lower respiratory tract infections and positive sputum cultures,un-dergone treatment in the RICU in Wuxi No. 2 People's Hospital from January to December of 2014,were enrolled in the study. The distribution of pathogens inducing lower respiratory tract infections and antimicrobi-al resistance were investigated,and the risk factors for multi-drug resistant bacterial infections were identified and statistically analyzed. Results A total of 161 pathogens were isolated from the 74 subjects,and the top 4 pathogens included Staphylococcus aureus (23.60%),Klebsiella pneumoniae (20.50%),Acinetobacter baumannii (16.15%) and Pseudomonas aeruginosa (9.94%). 106 strains of multi-drug resistant pathogens (65.84%) were identified,in which S. aureus (35.85%),K. pneumoniae (22.64%) and A.baumannii (14.15%) were prominent. Twelve strains of pan-drug resistant pathogens (7.45%)were associated with A. baumannii (11 strains) and K. pneumoniae (1 strain). Forty-nine of 74 patients (66.22%) were co-infected with at least two types of patho-gens,in whom 31 patients (41.89%) were co-infected with methicillin-resistant S. aureus. Logistic regression analysis indicated that Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) scoring was indepen-dent risk factor of multi-drug resistant bacterial infections. Conclusion Higher multi-drug resistant bacterial infections were observed in the patients with lower respiratory tract infections managed in RICU,and APACHEⅡis an independent risk factor of multi-drug resistant bacterial infections.
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