重症监护室溶血性葡萄球菌医院感染危险因素病例对照研究

A casecontrol study on risk factors for nosocomial Staphylococcus haemolyticus infections in intensive care units

摘要:

目的探讨重症监护室（ICU）溶血性葡萄球菌医院感染的危险因素。方法对某综合性三级甲等医院2007—2009年所有发生溶血性葡萄球菌医院感染的ICU患者(28例)进行1∶4 匹配的病例对照研究，并采用条件Logistic回归分析。结果单因素分析发现基础疾病数、入住ICU天数、住ICU调整天数、抗菌药物使用天数、联合使用抗菌药物、使用广谱抗菌药物、翻身拍背、吸痰、气管插管、使用呼吸机、留置鼻胃管及中心静脉置管与溶血性葡萄球菌医院感染有关。多因素回归分析显示，留置鼻胃管（OR=4.89）、使用呼吸机（OR=5.32）为溶血性葡萄球菌医院感染危险因素，而翻身拍背（OR=0.21）为保护因素。结论合理有效翻身拍背，使用无创通气及减少各种侵入性操作，将有利于预防和控制ICU溶血性葡萄球菌医院感染的发生。

Abstract:

ObjectiveTo evaluate the risk factors for nosocomial Staphylococcus haemolyticus (S. haemolyticus) infections (NIs) in intensive care units (ICUs) . MethodsA 1∶4 matched casecontrol study was carried out on ICU patients (28 cases) with S. haemolyticus NIs in an integrated hospital between 2007-2009. Conditional logistic regression analysis was adopted.ResultsUnivariate conditional logistic regression analysis showed that S. haemolyticus NIs were related with the number of underlying diseases，days of ICUs stay，adjusted days of ICUs stay， days of antimicrobial use， combination use of antimicrobials ，use of broadspectrum antimicrobials ，turning over and back patting，sputum aspiration，trachea intubation，use of ventilator，retention of nasogastric tube and central venous catheter. Multivariate logistic regression analysis showed that retention of nasogastric tube（OR=4.89） and ventilator（OR=5.32） were risk factors, and turning over and back patting（OR=0.21）were protective factors.ConclusionSound and effective practice of turning over and back patting ，use of noninvasive ventilation and reducing invasive procedures are helpful for the control and prevention of S. haemolyticus NIs.