作者：刘云，李艳秀，韩涛，李金海，左祥荣，张萍，曹权

单位：南京医科大学第一附属医院 重症医学科，江苏 南京 210029

Authors:  Liu Yun, Li Yanxiu, Han Tao, Li Jinhai, Zuo Xiangrong, Zhang Ping, Cao Quan

Unit:  Department of critical medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China

摘要：

目的 研究胃癌患者根治术后在重症监护室(intensive care unit, ICU)发生多重耐药菌(multidrug resistant bacterial infection, MDRS)感染的临床情况及危险因素。方法 选择2017年11月至2019年11月在南京医科大学第一附属医院行胃癌根治术后转入重症监护室的患者70例,对其病历及临床资料进行回顾性分析,对可能与MDRS感染发生的相关因素进行单因素与多因素分析。结果 经单因素分析,患者性别、APACHEⅡ评分、低蛋白血症、糖尿病、肝功能异常、应用糖皮质激素与患者发生MDRS感染无关,比较无显著差异(P>0.05);与年龄、总住院天数、ICU住院天数、急性脑血管疾病、有创机械通气时间、动静脉置管时间、留置导管时间、留置胃管时间、应用抗菌药物种类、应用抗菌药物时间、应用第三代头孢菌素有关,比较具有统计学意义(P<0.05);经Logistic回归分析急性脑血管疾病、应用抗菌药物种类及应用抗菌药物时间为MDRS感染发生的独立危险因素,比较差异具有统计学意义(P<0.05);本研究共检测出320株多重耐药菌,以革兰阴性球菌为主,占比87.81%,其中鲍曼不动杆菌204株,占比63.75%;金黄色葡萄球菌38株,占比11.88%;铜绿假单胞菌32株,占比10%;肺炎克雷伯菌27株,占比8.44%;大肠埃希菌17株,占比5.31%;肠球菌、变形杆菌各1株,占比0.62%。结论 胃癌患者术后在ICU发生MDRS感染的独立危险因素为合并急性脑血管疾病、应用抗菌药物种类以及应用抗菌药物时间,多重耐药菌主要以革兰阴性球菌为主。对于此类患者,应针对性的进行诊疗以及抗生素的使用,从而降低MDRS感染的发生率。  

关键词：  多重耐药菌感染; 重症监护室; 危险因素; 胃癌根治术; 临床情况

Abstract：

Objective To study the clinical situation and risk factors of MDRS infection in ICU after radical resection of gastric cancer. Methods 70 cases of patients transferred to ICU after radical gastrectomy in our hospital from November 2017 to November 2019 were selected for retrospective analysis of their medical records and clinical data, and univariate and multivariate analysis of possible factors related to MDRS infection. Results By single factor analysis, and patients' gender, APACHE Ⅱ score, hypoalbuminemia, diabetes, abnormal liver function, application of glucocorticoid has nothing to do with patients MDRS infection, was no significant difference (P>0.05); Age, total hospitalization days, ICU hospitalization days, acute cerebrovascular diseases, invasive mechanical ventilation time, arteriovenous catheterization time, indwelling catheter time, indwelling gastric tube time, application of antibacterial drugs, application of antibacterial drugs, application of the third generation cephalosporins, the comparison was statistically significant (P<0.05). Logistic regression analysis was performed to analyze the independent risk factors for MDRS infection, including acute cerebrovascular disease, the type and duration of antimicrobial use (P<0.05). This study detected 320 strains, multi-resistant bacteria mainly gram-negative coccus, accounted for 87.81%, of which 204 strains of acinetobacter baumannii, accounted for 63.75%, staphylococcus 38 strains, accounted for 11.88%, 32 strains of pseudomonas aeruginosa, accounted for 10%, 27 strains of klebsiella pneumoniae, accounted for 8.44%, 17 strains of e. coli, accounted for 5.31%, 1 strain of enterococcus, proteus, accounted for 0.62%. Conclusion The independent risk factors for MDRS infection in the ICU of gastric cancer patients after surgery were acute cerebrovascular disease, the types and duration of antimicrobial use, and the multi-drug resistant bacteria were mainly gram-negative coccus. For such patients, targeted treatment and antibiotic use should be conducted to reduce the incidence of MDRS infection.

Key Words:  Multidrug resistant bacterial infection infection; Intensive care unit; Hazards; Radical gastrectomy; Clinical situations