难愈性创面感染耐甲氧西林金黄色葡萄球菌危险因素

Risk factors for methicillinresistant Staphylococcus aureus infection of refractory wound

摘要:

目的探讨难愈性创面感染耐甲氧西林金黄色葡萄球菌（MRSA）的危险因素，为临床防控提供依据。方法对2006年1月—2013年12月某院烧伤外科难愈性创面分离出金黄色葡萄球菌患者的临床资料进行分析，根据细菌是否为甲氧西林耐药菌和是否来源于难愈性创面分为4组，分析难愈性创面感染MRSA的危险因素及其持续存在的危险因素。结果共112例次创面分泌物标本培养出金黄色葡萄球菌，难愈性创面MRSA组与难愈性创面甲氧西林敏感金黄色葡萄球菌（MSSA）组患者在住院时间、近期使用侵入性操作和近期使用抗菌药物治疗3个方面比较，差异具有统计学意义（均P＜0.05）；非条件logistic回归分析显示，住院时间＞30 d(OR 95% CI：1.14~30.69)和近期有侵入性操作(OR 95% CI：1.41~17.84)是难愈性创面MRSA感染的独立危险因素。难愈性创面MRSA组与非难愈性创面MRSA组患者在既往MRSA感染史、创面深度、近期手术治疗和近期使用抗菌药物治疗4个方面比较，差异具有统计学意义（均P＜0.05）；非条件logistic回归分析结果显示，近期使用抗菌药物治疗(OR 95% CI：2.080~26.800）是难愈性创面MRSA感染持续存在的独立危险因素。结论缩短创面感染患者住院时间、减少侵入性操作和合理使用抗菌药物有助于防控难愈性创面患者感染MRSA。

Abstract:

ObjectiveTo explore the risk factors for methicillinresistant Staphylococcus aureus (MRSA) infection of refractory wound, and provide reference for clinical prevention and control.  MethodsClinical data of patients who were isolated Staphylococcus aureus (SA) from wound at the burn ward in a hospital from January 2006 to December 2013 were analyzed, patients were divided into four groups according to whether the isolated SA were MRSA and whether  SA  were from refractory wound or from nonrefractory wound. Risk factors for MRSA infection of refractory wound were analyzed.ResultsA total of 112 isolates of SA were isolated from wound, statistical differences existed in the length of hospital stay, recent invasive operation, and recent antimicrobial use between patients in refractory wound MRSA group and refractory wound methicillinsensitive SA (MSSA) group (all P<0.05); nonconditional logistic regression analysis revealed that length of hospital stay>30 days (OR 95% CI：1.14-30.69) and recent invasive operation (OR 95% CI：1.41-17.84)were independent risk factors for refractory wound MRSA infection. There were statistically differences in previous MRSA infection, burn depth, recent operation and recent antimicrobial use between refractory wound MRSA group and nonrefractory wound MRSA group(all P<0.05) ; nonconditional logistic regression analysis revealed that recent antimicrobial use (OR 95% CI：2.080-26.800） was independent risk factor for the persistence of MRSA infection  of refractory wound. ConclusionShortening the length of hospital stay, reducing invasive operation, and using antimicrobial agents rationally are helpful for the prevention and control of MRSA infection of refractory wound.