摘要
目的分析医院获得性肺炎(HAP)患者多重耐药菌检出情况及其临床分布特点、易感因素与干预措施。方法选取2014年1月至2018年10月间该院各科室出现的HAP患者作为研究对象,采用无菌集痰管采集痰样本,分析HAP患者多重耐药菌检出情况及其临床分布特点、易感因素与干预措施。依照临床指征、病情、影像学检查、微生物检查结果对治疗疗效进行评估;依照《全国临床检验操作规程》对临床样本进行微生物培养、鉴定,采用K-B纸片扩散法行药敏检查。结果在HAP患者中鲍曼不动杆菌占比最高,且多重耐药菌感染患者鲍曼不动杆菌占比显著高于非多重耐药菌患者(P<0.05);在各科室中呼吸内科及ICU科室中HAP感染患者占比明显高于其他科室,差异有统计学意义(P<0.05);从其他机构转入、近期接受抗菌治疗、感染类型及住院时间≥5 d是影响多重耐药菌致HAP的独立性危险因素(P<0.05);多重耐药菌患者的用药频次、计量规范及联合用药合理性显著低于非多重耐药菌(P<0.05)。结论HAP多重耐药菌感染患者中以鲍曼不动杆菌感染最为常见,呼吸内科及ICU科室最为常见,从其他机构转入、近期接受抗菌治疗、感染类型及住院时间≥5 d均是影响HAP多重耐药菌感染的独立性危险因素并应注重采用合理性及规范性药物进行治疗。
Objective To analyze the detection of multi-drug-resistant bacteria in HAP patients and their clinical distribution characteristics,susceptible factors and intervention measures.Methods The patients with HAP in our hospital from January 2014 to October 2018 were selected as the research objects.The sputum samples were collected by sterile sputum collecting tube to analyze the detection of multi-drug-resistant bacteria in HAP patients and their clinical distribution characteristics,susceptible factors and intervention measures.The therapeutic efficacy was evaluated according to the clinical indications,condition,imaging examination and microbiological examination results;the clinical samples were cultured and identified according to the National Practice for Clinical Laboratory,and the drug sensitivity was tested by K-B disk diffusion method.Results Among HAP patients,Acinetobacter baumannii accounted for the highest proportion,and Acinetobacter baumannii accounted for a significantly higher proportion in patients infected with multi-drug resistant bacteria than in patients infected with non-multi-drug resistant bacteria(P<0.05);in departments of respiratory medicine and ICU,the proportion of patients infected with HAP was significantly higher than that in other departments,and the difference was statistically significant(P<0.05);The duration of hospitalization(≥5 days)was an independent risk factor for HA P induced by multi-drug-resistant bacteria(P<0.05).The frequency of drug use,measurement criteria and rationality of combined drug use in patients with multi-drug-resistant bacteria were significantly lower than those of non-single-drug-resistant bacteria(P<0.05).Conclusion Acinetobacter baumannii infection is the most common in HAP patients with multi-drug-resistant bacteria infection.Respiratory medicine and ICU departments are the most common.Transfer from other institutions,recent antibiotic treatment,infection type and hospitalization time(≥5 days)are independent risk factors affecting HAP infection with multi-drug-resistant bacteria.Rationality and standardized drugs should be emphasized for treatment.
作者
张红梅
张玉
ZHANG Hongmei;ZHANG Yu(Department of Clinical Laboratory,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi,Xinjiang 832008,China)
出处
《国际检验医学杂志》
CAS
2019年第18期2238-2241,共4页
International Journal of Laboratory Medicine
关键词
医院获得性肺炎
多重耐药菌
临床分布
易感因素
干预措施
hospital-acquired pneumonia
multidrug-resistant bacteria
clinical distribution
susceptibility factors
intervention measures
