| Objective To understand the species distribution,source distribution,and drug resistance of multi-drug resistant bacteria in nosocomial infections of ICU patients,and analyze the related risk factors,so as to strengthen the monitoring of multiple drug-resistant bacteria and application management of antibacterial drugs,so as to provide basis for rational drug use in clinics.Put forward effective preventive measures.Methods(1)We retrospectively collected pathogenic bacteria from the ICU wards in our hospital from June 2014 to June 2017.The results were consistent with nosocomial infection multi-drug resistant pathogens.The data were analyzed for the species distribution,source distribution,and drug resistance of multi-drug resistant bacteria in nosocomial infections.(2)Clinical data and statistics of all patients with multi-drug resistant bacteria nosocomial infection and non-multidrug resistant bacteria nosocomial infectionin in the ICU ward from June 2014 to June 2017 were collected retrospectively.Analyze the patient’s gender,age,length of stay in the ICU,and whether they have the following diseases: diabetes,COPD,cirrhosis,uremia,malignancy,and whether including the following invasive procedures: CVP,invasive mechanical ventilation,urinary catheter,gastric tube,thoracic puncture,abdominal puncture,with or without hormones,immunosuppressive agents,whether with chemotherapy or radiotherapy,whether with antibiotics,and the type and duration of using antibiotics are related factors for the development of multiple drug-resistant bacteria.Results(1)Distribution of multidrug-resistant pathogens in nosocomial infection of ICU: 1978 strains of pathogenic bacteria were detected in ICU from June 2014 to June2017,of which 433 were multi-drug resistant strains,which were consistent with nosocomial multi-drug-resistant strains of the 191 strains,a total of 70 strains of pan-resistant strains were Acinetobacter baumannii.There were 152 gram-negative bacteria,accounting for 79.6%,and 39 gram-positive bacteria,accounting for 20.4% of the191 nosocomial infections.Gram-negative bacteria are mainly Acinetobacter baumannii.Gram-positive bacteria are most common with Staphylococcus aureus.A total of 64 strains of ESBL-producing bacteria were detected,the top three positions are 36 strains(56.2%)of Acinetobacter baumannii,14 strains(21.8%)of Klebsiella pneumoniae and 6 strains of E.coli(9.3%).(2)Nosocomial multi-drug resistant bacteria in the ICU ward were mainly derived from the respiratory tract,a total of 130 cases,accounting for 68%.(3)Analysing the drug resistance of multidrug-resistant bacteria in nosocomial infection of ICU: Among the gram-negative bacteria,the first three were Acinetobacter baumannii(62.5%),Pseudomonas aeruginosa(17.8%),and pneumonia.Leiberia(7.8%).The resistance rate of Acinetobacter baumannii to most antibiotics was extremely high,and the resistance rate to cefoperazone sulbactam was relatively lowest,being 66.32%.The resistance rate of Pseudomonas aeruginosa to amikacin was lower,which was 25.93%.The resistance rates to other antibiotics were high,and the resistance rates to imipenem and meropenem were over 95%.Klebsiella pneumoniae had lower resistance rates to amikacin(28.57%)and minocycline(38.46%),and the resistance rates to many types of antibiotics reached 100%.Gram-positive bacteria were mainly Staphylococcus aureus,accounting for 59%,and their sensitivities to lizazolamide and vancomycin were 100%,and they had lower resistance rates to sulfamethoxazole(13.04%)and chloramphenicol(17.39%),and the rates of resistance to other types of antibiotics are high.(4)After single factor analysis of multi-drug resistant infection,which was found that multi-drug resistance groups usually have the following characteristics compared to non-multidrug-resistant groups: more than15 days of stay in the ICU,use of antibiotics,antibiotic use ≥ 3 species,antibiotic use duration> 2 weeks,invasive mechanical ventilation,indwelling urinary catheter,use of hormones or immunosuppressants.Logistic multivariate regression analysis found that the use of antibiotics,invasive mechanical ventilation,the use of hormones or immunosuppressive agents are independent risk factors for multidrug-resistant infections.Conclusion The multi-drug resistant bacteria in ICU hospital infections are mainly Gram-negative bacteria mainly caused by Acinetobacter baumannii.The infection sources are mainly concentrated in the respiratory tract.With the multi-drug resistant Acinetobacter baumannii nosocomial infection,the best choice for treatment is cefoperazone sulbactam.With the multi-drug resistant Pseudomonas aeruginosa nosocomial infection,the best choice for treatment is amikacin.With the multi-drug resistant Klebsiella pneumoniae nosocomial infection,the best choice for treatment is amikacin.With the multi-drug resistant Staphylococcus aureus nosocomial infection,the best choice for treatment is propofol,vancomycin.The use of antibiotics,invasive mechanical ventilation,the use of hormones or immunosuppressive agents are independent risk factors for multidrug-resistant infections. |
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