呼吸重症监护病房2008年至2011年医院感染病原菌分布及危险因素分析

目的：对我院呼吸重症监护病房（RICU）临床分离的非重复性感染病原菌的耐药性进行调查,分析RICU院内感染的危险因素。方法：收集RICU 2008年-2011年临床分离的非重复性感染病原菌及相关临床资料分析医院感染的危险因素。结果：（1）2008-2011年RICU院内感染发生率为34.15%,每年分离的前3位病原菌均为鲍曼不动杆菌、金黄色葡萄球菌及铜绿假单胞菌;（2）大肠杆菌连续4年ESBLs检出率为100%,四年间肺炎克雷伯菌ESBLs检出率最高达95.5%,葡萄球菌中MRSA检出率较高（〉89.6%）;（3）RICU院内感染以下呼吸道感染最为常见,其次为泌尿道感染,血液感染位于第3位;（4）多因素非条件logistic回归分析发现机械通气、住院时间〉15天及联合应用抗菌药物是RICU医院感染的危险因素。结论：（1）连续4年RICU感染病原菌以革兰阴性杆菌为主;（2）ESBLs和MRSA检出率较高,给临床抗感染治疗带来巨大的挑战;（3）机械通气、住院时间〉15天及联合应用抗菌药物是RICU医院感染的危险因素。

Survey of the Distribution of Nosocomial Infection Pathogenic and Analysis of the Risk Factors of Infection from 2008 to 2011 in Respiratory Intensive Care Unit

Objective： To investigate the drug resistance rate of non-repetitively clinical isolated pathogen to antiseptics and to analyze risk factors of nosocomial infections in respiratory intensive care unit. Methods： We the non-repetitively clinical isolated pathogens and relevant clinical data in respiratory intensive care unit of Xijing hospital from 2008 to 2011, and analyzed risk factors of nosocomial infections. Results： （1）incidence rate of nosocomial infections was 34.15% in RICU from 2008 to 2011. The first three clinical isolated pathogens were Acinetobacter baumannii, Staphylococcus aureus and Pseudomonas aeruginosa every year. （2）From 2008 to 2011, the detection rate of ESBLs was 100% in E. coli, and it was 95.5% in Klebsiella pneumoniae. The detection rate of MRSA in Staphylococci was more than 90%. （3）Lower respiratory tract infection （LRTI） was more frequent in nosocomial infections in RICU. Incidence rate of urinary tract infection was less than LRTI. The third one was blood infection. （4）Multivariate logistic regression analysis found that Length of stay more than 15 days, mechanical ventilation and combined use of antibiotics were risk factors of nosocomial infections in RICU. Conclusion： （1）Gram-negative bacillus were the major infection pathogens in RICU from 2008 to 2011. （2）Detection rates of ESBLs and MRSA were very high, which were still big challenges to anti-infective therapy. （3）Length of stay more than 15 days, mechanical ventilation and combined use antibiotics were risk factors ofnosocomial infections in RICU.