摘要
目的研究导尿管相关尿路感染(CAUTI)老年患者多重耐药菌(MDRO)感染情况并分析感染因素。方法选取江苏省人民医院2021年1月至2022年7月收治的175例CAUTI老年患者的病历资料,统计CAUTI老年患者MDRO感染分布情况,分析相关MDRO感染的影响因素。通过受试者工作特征(ROC)曲线分析独立危险因素对相关医院感染的预测价值。结果175例CAUTI老年患者中,87例(49.71%)发生MDRO感染(纳入MDRO感染组),88例(50.29%)未发生MDRO感染(纳入非MDRO感染组)。MDRO感染组检出MDRO病原菌432株,其中革兰氏阴性菌415株(96.06%),主要为耐碳青霉烯类鲍曼不动杆菌186株(43.06%),耐碳青霉烯类肺炎克雷伯菌147株(34.03%),耐碳青霉烯类铜绿假单胞菌79株(18.29%)及耐青耐碳青霉烯类大肠埃希菌3株(0.69%);革兰氏阳性菌17株(3.94%),均为耐甲氧西林金黄色葡萄球菌。多因素分析结果显示,使用碳青霉烯类、替加环素、多黏菌素,以及中心静脉插管时间长为独立危险因素,采用这4项自变量对CAUTI老年患者MDRO感染风险进行预测,ROC曲线下面积为0.883。结论针对CAUTI老年患者,要采取严格的抗菌药物管理措施,掌握抗菌药物的应用指征,缩短患者住院时间,降低MDRO感染发生率。
Objective To study the infection of multidrug-resistant organism(MDRO)in elderly patients with cat heter-associated urinary tract infection(CAUTI)and analyze the infection factors.Methods The medical records of 175 elderly patie nts with CAUTI admitted to Jiangsu Province Hospital from January 2021 to July 2022 were selected,the distribution of MDRO infection in elderly patients with CAUTI was analyzed,and the influencing factors of MDRO infection were analyzed.The predictive value of independent risk factors for relevant nosocomial infections was analyzed by receiver operating characteristics(ROC)curves.Results Among the 175 elderly patients with CAUTI,87 cases(49.71%)developed MDRO infection and were included in the MDRO infection group),and 88 cases(50.29%)had no MDRO infection and were included in the non-MDRO infection group.A total of 432 MDRO pathogens were detected in the MDRO infection group,including 415 strains of Gram-negative bacteria,accounting for 96.06%,186 strains of carbapenem-resistant Acinetobacter baumannii(43.06%),147 strains of carbapenem-resistant Klebsiella pneumoniae(34.03%),79 strains of carbapenem-resistant Pseudomonas aeruginosa(18.29%)and 3 strains of carbapenem-resistant Escherichia coli(0.69%).There were 17 strains of Gram-positive bacteria(3.94%),all of which were methicillin-resistant Staphylococcus aureus.Multivariate analysis showed that the use of carbapenems,tigecycline,polymyxin,and days of central venous intubation were considered as independent risk factors.The area under the curve of MDRO infection was 0.883.Conclusion For elderly patients with CAUTI,it is necessary to take strict antimicrobial management measures,master the indications of antimicrobial application,shorten the hospitalization time of patients and reduce the incidence of MDRO infection.
作者
刘娟
张小霞
臧凤
李松琴
李占结
崔婷
王科
赖晓莹
张东芳
LIU Juan;ZHANG Xiaoxia;ZANG Feng;LI Songqin;LI Zhanjie;CUI Ting;WANG Ke;LAI Xiaoying;ZHANG Dongfang(Department of Infection Management,Jiangsu Provincial People’s Hospital/the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;Office of Healthcare-Associated Infection Management,Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine,Shanghai 200081,China;Department of Medical,Shanghai Fourth People’s Hospital Affiliated to Tongji University,Shanghai 200081,China;Department of Science and Education,Jiangwan Hospital of Hongkou District,Shanghai 200081,China)
出处
《重庆医学》
CAS
2024年第10期1519-1524,共6页
Chongqing medicine
基金
国家重点研发计划项目(2020YFC0848100)
中国老年医学学会感染防控研究基金项目(GRYJ-LRK2018016)
江苏省医院协会医院管理创新研究课题(JSYGY-3-2020-692,JSYGY-3-2019-48)
江苏省人民医院第三期优秀中青年人才培养项目(YNRCQN0314)
南京医科大学第一附属医院青年基金培育计划项目(PY2022017)。
关键词
老年
多重耐药菌
导管相关性尿路感染
危险因素
elderly
multi-drug resistant bacteria
catheter-associated urinary tract infection
risk factors
