Analysis Of Pathogen And Related Factors Of Multiple Trauma Patients With Nosocomial Infection In Intensive Care Unit

Objective:To investigate possible related factors of multiple trauma patients with nosocomial infection and mortality of nosocomial infection patients in Intensive Care Unit.Methods:Specimens,such as blood serum,sputum,urine,canal of cuvier,and secretion of wound surface etc.,of 265 inpatient cases of Intensive Care Unit were collected.Strains of bacterium in the specimens were identified and antibiotic sensitivities were detected by VITEK TWO automatic bacterium analyses system. APACHEⅡscore,ISS score,the days of mechanical ventilation,the days in ICU,the volume of RBC and blood plasma transfusion,liver function,kidney function,blood routine,blood clotting function and 28 days' prognosis were recorded.Statistics were used to analyze possible related factors of multiple trauma patients with nosocomial infection and mortality of nosocomial infection patients.Results:106 specimens were identified containing pathogens and the incidence of nosocomial infection was 36.9%(98/265).Sixty two strains(58.5%)of the pathogens were Gram-negative bacilli,which were baumanii(19/106,17.9%), Pseudomonas aeruginosa(15/106,14.2%),Klebsiella pneumoniae(13/106,2.3%), Escherichia(7/106,6.6%),Aerobacter cloacae(5/106,4.7%),and Stenotrophomonas maltophilia(3/106,2.8%);Gram-positive bacilli contained 33 strains(31.1%),which were Staphylococcus aureus(16/106,15.1%),staphylococci haemolysis(7/106,6.6 %),enterococci(6/106,5.6%),and Staphylococcus epidermidis(4/106,3.8%);And 11 strains(10.4%)were Fungous infections,which were Blastomyces albicans(4/106, 3.8%),Candida tropicalis(4/106,3.8%),and Slick Candida mycoderma(3/106, 2.8%).Drug resistance to common antibiotics of the pathogens listed first to fourth was:The susceptibility rates of baumanii to meropenem and imipenem were above 80%and to piperacillin/tazobactam,cefepime and amikacin were above 80%;The susceptibility rates of Pseudomonas aeruginosa to meropenem,amikacin and piperacillin/tazobactam were 80%and to imipenem and ceflazidime were about 70%; The susceptibility rates of Klebsiella pneumoniae to meropenem and imipenem were 100%and to piperacillin/tazobactam,cefepime,ceflazidime and amikacin were above 70%;The susceptibility rates of Staphylococcus aureus to vancomycin and teicoplanin were 100%and to rifampicin,phosphonomycin and amphemycin were above 80%.The common positions of nosocomial infection of multiple trauma patients in Intensive Care Unit were lung(64/98,65.3%),blood(10/98,10.2%), urinary system(7/98,7.1%),canal of cuvier(5/98,5.1%)and wound surface(4/98, 4.1%);Singal factor variance analysis showed that APACHEⅡscore,ISS score,the days of mechanical ventilation,the days in ICU,the volume of RBC and blood plasma transfusion were significant deviation between infected group and non-infected group(P＜0.01);APACHEⅡscore,ISS score,the days of mechanical ventilation,the days in ICU were significant deviation between death group and nondeath group in infected group(P＜0.01);Multiple factor model,used by stepwise regression to logistic regression analysis,showed that APACHEⅡscore and the days in ICU were positive correlation to nosocomial infection(P＜0.01);APACHEⅡscore and the days in ICU were positive correlation to mortality of infected group(P＜0.05).Conelusions:There were higher nosocomial infections in multiple trauma patients in Intensive Care Unit.APACHEⅡscore and the days in ICU were important factors impacting nosocomial infections.Mortality of infected group were obviously higher than that of non-infected group.APACHEⅡscore and the days in ICU were also important factors impacting mortality of infected group.