2018-2020年泰州市某医院烧伤科患者多重耐药菌感染危险因素分析-东南大学学报医学版

2018-2020年泰州市某医院烧伤科患者多重耐药菌感染危险因素分析

单位：1. 泰州市人民医院感染管理科, 江苏泰州 225300;
2. 泰州市人民医院烧伤科, 江苏泰州 225300

分类号：R63

出版年·卷·期（页码）：2022·41·第六期（812-817）

摘要：

目的: 分析2018-2020年泰州市某医院烧伤科患者多重耐药菌(MDROs)感染危险因素,为降低临床MDROs感染率提供理论依据。方法: 回顾性选择泰州市某医院感染管理科杏林监测系统中2018-2020年烧伤科住院患者医院感染病例信息,采用多因素Logistic回归分析感染相关危险因素。结果: 871例患者中,有60例发生MDROs感染,感染发生率为6.89%,共发生115例次,例次率13.22%。MDROs感染患者检出病原菌230株,排名前三的是肺炎克雷伯菌、鲍曼不动杆菌和金黄色葡萄球菌。感染部位以伤口创面为主,占61.74%。单因素分析结果表明,糖尿病、抗菌药物使用种类及时间、创面性质、手术史、首次手术后预防性使用抗菌药物、使用呼吸机、中心静脉置管、尿管插管9个因素与感染发生有关(P＜0.05)。多因素Logistic 回归分析结果显示,糖尿病(OR＝8.24)、抗菌药物联合使用种类(OR＝4.10)、抗菌药物使用时间(OR＝7.49)、尿管插管(OR＝5.49)是烧伤科住院病人MDROs感染的危险因素(P＜0.05)。结论: 烧伤科患者的临床诊疗活动中应规范抗菌药物的使用,重点关注基础疾病患者,减少侵入性操作。

Objective: To investigate the risk factors of multi-drug resistant organisms(MDROs) infection in burn unit patients from 2018 to 2020, and to provide theoretical basis for reducing clinical MDROs infection. Methods: The information of nosocomial infection cases in the burn unit inpatients from 2018 to 2020 was retrospectively selected from the monitoring system of Taizhou People's Hospital, and the infection-related risk factors were analyzed by multivariate Logistic regression. Results: Among 871 patients, 60 patients developed MDROs infections, with an infection rate of 6.89%, and 115 times of case infection occurred, with a rate of 13.22%. A total of 230 strains of pathogenic bacteria were detected in MDROs infected patients, and the top three were Klebsiella pneumoniae, Acinetobacter baumannii and Staphylococcus aureus. The site of infection was predominantly featured by wound surface, accounting for 61.74%. The results of univariate analysis showed that 9 factors, including diabetes, time of using antibacterial drugs, days of use of antibiotics, wound surface, surgical history, prophylactic use of antibiotics after the first operation, use of ventilator, central venous catheterization and indwelling urinary catheter,were related to the occurrence of infection(P＜0.05). Multivariate Logistic regression analysis showed that diabetes(OR＝8.24), types of antibacterial drugs used(OR＝4.10), time of using antibacterial drugs (OR＝7.49) and indwelling urinary catheter(OR＝5.49) were risk factors for MDROs infection. Conclusion: The use of antibiotics should be regulated in clinical diagnosis and treatment activities for burn unit patients. It is necessary to focus on patients with underlying diseases and reduce invasive operations.

参考文献：

[1] 黄跃生.烧伤外科学[M].北京:科学技术文献出版社,2010:175.
[2] LESEVA M,ARGUIROVA M,NASHEV D,et al.Nosocomial infections in burn patients:etiology,antimicrobial resistance,means to control[J].Ann Burns Fire Disasters,2013,26(1):5-11.
[3] ALGETHAMY M M,FAIDAH H S,ADETUNJI H A,et al.Risk factors associated with multi-drug resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah,Saudi Arabia-a matched case-control study[J].J Int Med Res,2017,45(3):1181-1189.
[4] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001(5):61-67.
[5] Clinical and Laboratory Standards Istitute.Performance standards for antimicrobials susceptibility testing:M100-S26[S].Wayne,PA,USA:CLSI,2016.
[6] ESSAYAGH M,ESSAYAGH T,ESSAYAGH S,et al.Epidemiology of burn wound infection in Rabat,Morocco:three-year review[J].Med Sante Trop,2014,24(2):157-164.
[7] 姚新宝,刘利华,张艳霞,等.烧伤科患者医院感染危险因素分析[J].中国病案,2016,17(8):62-64.
[8] 付妍婕,于凤娜,刘荣朋,等.2015-2016年烧伤科住院患者感染细菌分布及耐药性分析[J].山东医学高等专科学校学报,2018,40(1):5-9.
[9] 黄晓元.加强创面感染的防治[J].中华损伤与修复杂志,2015,10(5):376-379.
[10] SANTOS S M B,JUMAOAS J W L.604 Epidemiology and microbiologic profile of pediatric burn patients:Eight-years' Experience in a Tertiary Hospital[J].J Burn Care Res,2021,42(Suppl 1):S154-155.
[11] 张彦标,黄波,李先慧,等.某三甲医院烧伤病房烧伤感染的病原学特点[J].西南军医,2020,22(5):459-460.
[12] 高立平,易博,廖殿晓,等.烧伤科连续5年医院感染回顾性调查[J].中国感染控制杂志,2018,17(1):77-79.
[13] 周建文,王德怀,李丹,等.烧伤创面病原菌分布和耐药性分析[J].东南国防医药,2021,23(3):276-281.
[14] ALFADLI M,ELSEHSAH E M,RAMADAN M A.Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection[J].Germs,2018,8(4):199-206.
[15] ELSHAFIE S S,ALISHAQ M,LENI G M.Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit[J].J Hosp Infect,2004,56(2):101-105.
[16] ROSSI I,ROYER S,FERREIRA M L,et al.Incidence of infections caused by carbapenem-resistant Acinetobacter baumannii[J].Am J Infect Control,2019,47(12):1431-1435.
[17] SHARMA S,DATTA P,GUPTA V,et al.Characterization of bacteriological isolates from patients and environment samples of burn ward:a study from a tertiary care hospital of india[J].Infect Disord Drug Targets,2021,21(2):238-242.
[18] 郭艳,张玉洁,苏富萍,等.某院重症烧伤患者医院感染相关因素调查[J].中国消毒学杂志,2019,36(3):189-191.
[19] 陈国建,杨洁,邓艾,等.某综合医院常见多重耐药菌感染危险因素logistic回归分析[J].华西医学,2020,35(3):290-295.
[20] 吴标良,唐乾利,冯烈,等.烧伤皮肤再生医疗技术治疗糖尿病足部溃疡疗效的系统评价[J].中国全科医学,2014,17(32):3851-3854.
[21] STRASSLE P D,WILLIAMS F N,WEBER D J,et al.Risk factors for healthcare-associated infections in adult burn patients[J].Infect Cont Hosp Ep,2017,38(12):1441-1448.
[22] 杨永熙,冯佳雄,黄晓涛,等.糖尿病患者与非糖尿病患者下肢烧伤的治疗结局差异性及机制研究[J].中华损伤与修复杂志,2016,11(6):428-432.
[23] 陈皇胜,张振伟,文溢,等.多重耐药菌感染对骨科伤口感染治疗效果的影响[J].中华医院感染学杂志,2019,29(16):2478-2481.
[24] 车丽萍,王钧,陈瑛,等.长期卧床老年患者多药耐药菌感染影响因素[J].中华医院感染学杂志,2021,31(4):530-534.
[25] 杨军红,陈艳军.影响医院感染相关因素的Logistic回归分析[J].河南预防医学杂志,2021,32(4):291-293,300.
[26] 韩海霞,李月霞,夏娟娟,等.1229例ICU导尿管相关尿路感染的病原学及临床特点[J].中华医院感染学杂志,2021,31(18):2747-2750.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录