重癥監(jiān)護(hù)病房內(nèi)耐甲氧西林金黃色葡萄球菌感染的現(xiàn)狀分析
發(fā)布時(shí)間：2018-09-14 07:22
【摘要】：目的通過對(duì)耐甲氧西林金黃色葡萄球菌(MRSA)感染病例的調(diào)查,了解MRSA的感染現(xiàn)狀,探討重癥監(jiān)護(hù)病房內(nèi)MRSA感染的危險(xiǎn)因素、臨床特征及預(yù)后,為采取措施預(yù)防與控制MRSA感染提供依據(jù)。方法對(duì)我院2012年1月-2013年12月期間,對(duì)重癥監(jiān)護(hù)病房(intensive care unit,ICU)內(nèi)787例患者進(jìn)行了MRSA感染監(jiān)測。以2012-2013年我院ICU內(nèi)MRSA感染患者作為病例組,非MRSA感染患者作為對(duì)照組,采用流行病學(xué)研究方法,統(tǒng)計(jì)分析的變量主要依據(jù)綜述和臨床經(jīng)驗(yàn)來確定;使用SPSS 17.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,應(yīng)用非條件Logistic回歸分析對(duì)資料進(jìn)行單因素分析與多因素分析,尋找MRSA感染的獨(dú)立危險(xiǎn)因素。對(duì)實(shí)驗(yàn)室指標(biāo)(血常規(guī)、肝腎功能、凝血功能、血?dú)夥治�、心肌壞死�?biāo)記物等)與MRSA感染的關(guān)系進(jìn)行兩獨(dú)立樣本t檢驗(yàn);對(duì)MRSA感染的死亡率、肺功能障礙發(fā)生率、肝功能障礙發(fā)生率等進(jìn)行卡方檢驗(yàn)。結(jié)果1.86例金黃色葡萄球菌(SA)感染患者中,54例為MRSA感染病例,MRSA感染發(fā)生率為62.79%;2012年感染率為68.18%,2013年感染率為57.14%(χ2=1.121,P=0.290);787例住院患者中,MRSA發(fā)病率為6.86%,其中,2012年MRSA發(fā)病率為8.13%,2013年發(fā)病率為5.74%(χ2=1.749,P=0.186)。2.納入單因素分析的變量共62個(gè),經(jīng)過統(tǒng)計(jì)分析,篩選出12個(gè)變量進(jìn)入多因素Logistic回歸模型;年齡(OR=1.047,95%CI:1.009~1.086)、ICU住院天數(shù)(OR=1.050,95%CI:1.012~1.089)、使用激素/免疫抑制劑(OR=2.853,95%CI:1.177~6.911)、機(jī)械通氣(OR=4.918,95%CI:1.175~20.583)、抗菌藥物使用超過7天(OR=3.257,95%CI:1.055~10.058)是MRSA感染的獨(dú)立危險(xiǎn)因素;MRSA感染組進(jìn)行機(jī)械通氣的暴露率為92.59%,對(duì)照組進(jìn)行機(jī)械通氣的暴露率為59.21%(χ2=23.673,P0.001);MRSA感染組使用激素的暴露率為62.96%,而對(duì)照組使用激素的暴露率為25.24%(χ2=35.64,P0.001);MRSA感染組抗菌藥物使用≥7d的暴露率為74.07%,而對(duì)照組抗菌藥物使用≥7d的暴露率為20.87%(χ2=76.90,P0.001);MRSA感染組使用廣譜抗菌藥物的暴露率為81.48%,而對(duì)照組使用廣譜抗菌藥物的暴露率為66.44%(χ2=5.185,P=0.023)。3.共收集天津醫(yī)科大學(xué)第二醫(yī)院2年時(shí)間內(nèi)非重復(fù)MRSA菌株54株,經(jīng)分析統(tǒng)計(jì),所有產(chǎn)生MRSA的標(biāo)本中,痰液占30株(55.56%),肺泡灌洗液占14株(25.93%),咽拭子占8株(14.81%),血液占2株(3.70%)。4.對(duì)兩組的臨床生化指標(biāo)進(jìn)行獨(dú)立樣本t檢驗(yàn)后得出,MRSA感染組的平均血小板計(jì)數(shù)為(220.74±88.81)*109/L,對(duì)照組的平均血小板計(jì)數(shù)為(183.92±102.04)*109/L,兩組的平均血小板計(jì)數(shù)有顯著性差異(t=2.492,P=0.013);MRSA感染組的平均實(shí)際HCO3-為(24.43±8.07)mmol/L,非MRSA感染組的平均HCO3-為(21.85±7.56)mmol/L,兩組的平均實(shí)際HCO3-有顯著性差異(t=2.282,P=0.023)。5.MRSA感染組的平均ICU住院時(shí)間為(24.94±33.19)d,而非MRSA感染組的的平均ICU住院時(shí)間為(7.69±9.19)d,且兩組的差異有統(tǒng)計(jì)學(xué)意義(t=7.685,P0.001);MRSA感染組ALB28g/L有30例,的發(fā)生率為55.56%,對(duì)照組ALB28g/L的發(fā)生率為40.79%(χ2=4.506,P=0.034);MRSA組RR20次/分的發(fā)生率為62.96%,對(duì)照組RR20次/分的發(fā)生率為48.84%(χ2=4.013,P=0.045)。結(jié)論高齡、長期住院、進(jìn)行機(jī)械通氣、使用激素/免疫抑制劑、長期使用抗菌藥物是ICU內(nèi)MRSA感染的獨(dú)立危險(xiǎn)因素;MRSA感染導(dǎo)致血小板計(jì)數(shù)及實(shí)際HCO3-增高,并且延長了患者的住院時(shí)間;MRSA感染組肝、肺功能障礙的發(fā)生率更高。應(yīng)根據(jù)患者病情特點(diǎn),積極采取預(yù)防控制措施,防止耐藥菌的產(chǎn)生和傳播。
[Abstract]:Objective To investigate the infection status of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care unit (ICU), to explore the risk factors, clinical features and prognosis of MRSA infection, and to provide evidence for the prevention and control of MRSA infection. 787 patients in intensive care unit (ICU) were monitored for MRSA infection. The patients with MRSA infection in ICU from 2012 to 2013 were selected as the case group and the patients without MRSA infection as the control group. Epidemiological methods were used. The variables of statistical analysis were mainly determined by summary and clinical experience. SPSS 17.0 software was used to integrate the data. Univariate analysis and multivariate analysis were used to identify independent risk factors for MRSA infection. Two independent t-test samples were used to examine the relationship between laboratory parameters (blood routine, liver and kidney function, coagulation function, blood gas analysis, myocardial necrosis markers, etc.) and MRSA infection. Results Among 1.86 cases of Staphylococcus aureus (SA) infection, 54 cases were MRSA infection, and the incidence of MRSA infection was 62.79%. The infection rate in 2012 was 68.18%. The infection rate in 2013 was 57.14%(2=1.121, P=0.290). Among them, the incidence of MRSA was 8.13% in 2012 and 5.74% in 2013 (2 = 1.749, P = 0.186). 62 variables were included in the univariate analysis. After statistical analysis, 12 variables were selected into the multivariate logistic regression model; age (OR = 1.047, 95% CI: 1.009-1.086), length of stay in ICU (OR = 1.050, 95% CI: 1.012-1.089), hormone / immunosuppressive therapy was used. Preparations (OR = 2.853,95% CI: 1.177-6.911), mechanical ventilation (OR = 4.918,95% CI: 1.175-20.583), antimicrobial use more than 7 days (OR = 3.257,95% CI: 1.055-10.058) were independent risk factors for MRSA infection; exposure rate of mechanical ventilation in MRSA infection group was 92.59%, and that of control group was 59.21% (2 = 23.673, P 0.001). The exposure rate of using hormones in the infected group was 62.96%, while that in the control group was 25.24% (2 = 35.64, P 0.001); that in the MRSA infected group was 74.07% after using antibiotics for more than 7 days, and that in the control group was 20.87% (2 = 76.90, P 0.001); that in the MRSA infected group was 81.48% after using broad-spectrum antibiotics, while that in the control group was 74.07%. The exposure rate of the control group to broad-spectrum antibiotics was 66.44% (_2 = 5.185, P = 0.023). A total of 54 strains of non-repetitive MRSA were collected from the Second Hospital of Tianjin Medical University in two years. According to the analysis and statistics, 30 strains (55.56%) were sputum, 14 strains (25.93%) were alveolar lavage fluid, 8 strains (14.81%) were throat swabs, and 2 strains (3.70%) were blood. 4. The average platelet count in MRSA infection group was (220.74 [88.81] * 109/L, and that in control group was (183.92 [102.04] * 109/L. There was a significant difference in the average platelet count between the two groups (t = 2.492, P = 0.013). 7) mmol / L, the average HCO3 - in the non-MRSA infection group was (21.85 (7.56) mmol / L, and the average actual HCO3 - in the two groups was significantly different (t = 2.282, P = 0.023). 5. The average ICU hospitalization time in the MRSA infection group was (24.94 (33.19) days, while the average ICU hospitalization time in the non-MRSA infection group was (7.69 (9.19) days, and the difference between the two groups was statistically significant (t = 7.685, P 0.001). The incidence of ALB28g/L in MRSA infection group was 55.56%. The incidence of ALB28g/L in control group was 40.79%(2=4.506,P=0.034). The incidence of RR20 times/min in MRSA group was 62.96%. The incidence of RR20 times/min in control group was 48.84%(2=4.013,P=0.045). Antimicrobial agents are independent risk factors for MRSA infection in ICU. MRSA infection leads to increased platelet count and actual HCO3 - and prolongs hospitalization time. The incidence of liver and lung dysfunction is higher in MRSA infection group. Preventive and control measures should be taken to prevent the emergence and spread of drug-resistant bacteria according to the characteristics of patients.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5
本文編號(hào)：2241979
[Abstract]:Objective To investigate the infection status of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care unit (ICU), to explore the risk factors, clinical features and prognosis of MRSA infection, and to provide evidence for the prevention and control of MRSA infection. 787 patients in intensive care unit (ICU) were monitored for MRSA infection. The patients with MRSA infection in ICU from 2012 to 2013 were selected as the case group and the patients without MRSA infection as the control group. Epidemiological methods were used. The variables of statistical analysis were mainly determined by summary and clinical experience. SPSS 17.0 software was used to integrate the data. Univariate analysis and multivariate analysis were used to identify independent risk factors for MRSA infection. Two independent t-test samples were used to examine the relationship between laboratory parameters (blood routine, liver and kidney function, coagulation function, blood gas analysis, myocardial necrosis markers, etc.) and MRSA infection. Results Among 1.86 cases of Staphylococcus aureus (SA) infection, 54 cases were MRSA infection, and the incidence of MRSA infection was 62.79%. The infection rate in 2012 was 68.18%. The infection rate in 2013 was 57.14%(2=1.121, P=0.290). Among them, the incidence of MRSA was 8.13% in 2012 and 5.74% in 2013 (2 = 1.749, P = 0.186). 62 variables were included in the univariate analysis. After statistical analysis, 12 variables were selected into the multivariate logistic regression model; age (OR = 1.047, 95% CI: 1.009-1.086), length of stay in ICU (OR = 1.050, 95% CI: 1.012-1.089), hormone / immunosuppressive therapy was used. Preparations (OR = 2.853,95% CI: 1.177-6.911), mechanical ventilation (OR = 4.918,95% CI: 1.175-20.583), antimicrobial use more than 7 days (OR = 3.257,95% CI: 1.055-10.058) were independent risk factors for MRSA infection; exposure rate of mechanical ventilation in MRSA infection group was 92.59%, and that of control group was 59.21% (2 = 23.673, P 0.001). The exposure rate of using hormones in the infected group was 62.96%, while that in the control group was 25.24% (2 = 35.64, P 0.001); that in the MRSA infected group was 74.07% after using antibiotics for more than 7 days, and that in the control group was 20.87% (2 = 76.90, P 0.001); that in the MRSA infected group was 81.48% after using broad-spectrum antibiotics, while that in the control group was 74.07%. The exposure rate of the control group to broad-spectrum antibiotics was 66.44% (_2 = 5.185, P = 0.023). A total of 54 strains of non-repetitive MRSA were collected from the Second Hospital of Tianjin Medical University in two years. According to the analysis and statistics, 30 strains (55.56%) were sputum, 14 strains (25.93%) were alveolar lavage fluid, 8 strains (14.81%) were throat swabs, and 2 strains (3.70%) were blood. 4. The average platelet count in MRSA infection group was (220.74 [88.81] * 109/L, and that in control group was (183.92 [102.04] * 109/L. There was a significant difference in the average platelet count between the two groups (t = 2.492, P = 0.013). 7) mmol / L, the average HCO3 - in the non-MRSA infection group was (21.85 (7.56) mmol / L, and the average actual HCO3 - in the two groups was significantly different (t = 2.282, P = 0.023). 5. The average ICU hospitalization time in the MRSA infection group was (24.94 (33.19) days, while the average ICU hospitalization time in the non-MRSA infection group was (7.69 (9.19) days, and the difference between the two groups was statistically significant (t = 7.685, P 0.001). The incidence of ALB28g/L in MRSA infection group was 55.56%. The incidence of ALB28g/L in control group was 40.79%(2=4.506,P=0.034). The incidence of RR20 times/min in MRSA group was 62.96%. The incidence of RR20 times/min in control group was 48.84%(2=4.013,P=0.045). Antimicrobial agents are independent risk factors for MRSA infection in ICU. MRSA infection leads to increased platelet count and actual HCO3 - and prolongs hospitalization time. The incidence of liver and lung dysfunction is higher in MRSA infection group. Preventive and control measures should be taken to prevent the emergence and spread of drug-resistant bacteria according to the characteristics of patients.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R446.5
【共引文獻(xiàn)】
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2 王立新;臨床血流感染患者金黃色葡萄球菌耐藥機(jī)制及分子流行病學(xué)研究[D];天津醫(yī)科大學(xué);2013年
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