Analysis Of The Baseline Characteristics Of Bacterial Spectrum And The Related Factors Of Drug-resistant Strains In Intensive Care Unit

Backgroud:Intensive Care Unit(ICU) is an important place where antibioticresistant bacteria come into being and spread.The infection of antibioticresistant bacteria influences the patients' outcome and increases medical cost.As antibiotic-resistance becomes more and more serious,its prevalence, mechanism,factors and prevention get more and more attention.Studies show that antibiotic-resistance is closely related to the usage of antibiotics,and optimized treatment strategies to prevent antibi-otic-resistance may play an important role,especially the interference and replacing strategies of antibiotics.Because of differences of antibiotic-resistance in different ICUS,we study the epidemiology,the quantitive relation between antibiotic-resistance and dose of antibiotics,the relation between Traditional Chinese Medicine(TCM) and drug resistance,and other factors,to provide practical and useful information to guide the clinical treatment of infection,and reduce the antibiotic-resistant level.Objective:To investigate the prevalence and factors of antibiotic-resistance in ICU,and the effect of restriction of the third generation cephalosporin and usage of antibiotics withβ-lactamase as substitute on antibiotic-ressistance.Methods:We conducted a retrospective study on 347 bacterial culture-positive patients with infection in the ICU of Foshan Traditional Chinese Medicine Hospital during the past 5 years(2004.1-2008.12),investigated the epidemiology,and analyzed factors of drug-resistant bacterial infection by logistic regression analysis.And two-component by linear regression analysis.Results:There were 689 strains of antibiotic-resistant bacteria cultured from 347 patients.Gram-negative bacteria accounted for 74.60%,and gram-positive bacteria 25.40%.The most common strains of gram-negative bacilli were Pseudomonas Aeruginosa,Klebsiella Pneumoniae,Anopheles Maltophilia Pseudomonas, E.coli Bacteria and Acinetobacter Baumannii.The infection incidence increased year after year.42.42%of them were found to be extended spectrumβ-lactamase(ESBL)-positive.Staphylococcus Aureus is the most common pathogen in gram-positive bacteria infection.Its infection incidence decreases in the whole,but the incidence of Methycillin-Resistant Staphylococcus Aureus(MRSA) increased by years.There were 93 Staphylococcus Aureus isolates.MRSA accounted for 39.78%,and all of them were sensitive to Vancomycin.The multivariate regression analysis showed that the risk factors of the drug-resistant bacterial infection were diabetes(OR=3.642,P＜0.01),posttracheostomy (OR=1.374,P＜0.01),in-hospital time(OR=1.018,P＜0.01) and the sum of different antibiotics(OR=1.895,P＜0.01).Both of immunoenhancer (OR=0.674,P＜0.05) and proprietary Chinese medicines(OR=2.447,P＜0.01) were closely related to drug-resistant bacterial infection.Incidence of ESBL-positive strains had a positive correlation with DDDs of Ceftazidime and the third generation cephalosporin,while negative with Piperacillin&Tazobactam Sodium and other antibiotics withβ-lactamase inhibitor. Additionally,proprietary Chinese medicines also impacted on the sum of antibiotics(r=-0.257,P＜0.01).Pseudomonas Aeruginosa,Escherichia Coli and Klebsiella Pneumoniae were positive with DDDs of Ceftazidime.Escherichia Coli was positive with Cefoperazone.It is showed that the drug-resistance is closely related to the frequency of the usage of the third generation cephalosporin,and antibiotics withβ-lactamase inhibitor can inhibitβ-lactamase's production from ESBL-positive strains.Conclusion:Antibiotic-resistance is affected by many factors,and becomes more and more serious in ICU.Restricting the usage of the third generation cephalosporin,using proprietary Chinese medicines to treat the blood circulation,clear away heat and toxic,and support healthy trends can reduce the incidence of drug-resistant and multidrug-resistant bacterial infection.