重症监护室患者下呼吸道医院感染危险因素分析

Risk factors for lower respiratory tract infection in patients in an intensive care unit

摘要:

目的探讨某院重症监护室(ICU)患者发生下呼吸道医院感染（LRTI）的危险因素，为制定控制医院感染的有效措施提供依据。方法收集2008年12月—2010年12月入住该院ICU且时间＞48 h、年龄≥18岁的1 062例患者病历资料，将其中确诊为LRTI的68 例患者作为实验组；按同性别、同年龄组、入院时间相近，以1︰2 配对形式，选择其中未发生医院感染的136例患者作为对照组，对发生LRTI的危险因素进行分析。结果单因素分析结果显示，ICU住院时间≥15 d、气管切开、气管插管/气管切开机械通气、使用抗菌药物>2种和抗菌药物使用时间>2周、雾化吸入等是引起ICU患者发生LRTI的危险因素；对筛选的9种危险因素进行条件Logistic分析，结果ICU住院时间≥15 d (OR 95% CI：1.153～4.912)、单纯气管切开(OR 95% CI：1.836～9.967)、气管插管/气管切开机械通气(OR 95% CI：1.163～5.774)、使用抗菌药物＞2种和抗菌药物使用时间＞2周(OR 95% CI：1.016～5.813)是ICU患者发生LRTI的独立危险因素。结论ICU患者发生LRTI是多种因素共同作用的结果，针对其危险因素制定综合的防控对策，有助于减少医院感染的发生。

Abstract:

ObjectiveTo investigate the risk factors for hospitalacquired lower respiratory tract infection（LRTI）in an intensive care unit (ICU) , so as to provide reference for making effective measures for controlling healthcareassociated infection(HAI).MethodsA retrospective analysis was conducted on medical records of 1 062 ICU patients who were admitted in ICU from December 2008 to December 2010, patients’ hopitalization time was >48 hours, ages were ≥18 years old, 68 patients who were confirmed LRTI was as case group; by 1:2 matched cases of same gender, same age group, and same admission time, 136 patients without HAI was as control group, risk factors for LRTI were analysed.ResultsUnivariate analysis showed that length of stay in ICU≥15 days , incision of trachea, endotracheal intubation/mechanical ventilation,use of antimicrobial agents >2 types and duration >2 weeks, aerosol inhalation were risk factors of LRTI in ICU patients; Multivariate Logistic regression analysis on 9 screened risk factors showed that length of stay in ICU ≥15 days (OR 95% CI, 1.153-4.912), incision of trachea (OR 95% CI, 1.836-9.967), endotracheal intubation/mechanical ventilation (OR 95% CI,1.163-5.774), use of antimicrobial agents >2 types and duration >2 weeks (OR 95% CI,1.016-5.813) were independent risk factors for LRTI.ConclusionMultiple factors contribute to the occurrence of LRTI in ICU patients,comprehensive preventive treatment based on the risk factors is helpful for reducing HAI.