The Investigation Of Bacteriology And Risk Factors Analysis Of CRPA In ICU Of The First Hospital Of Lanzhou University

Objective: In recent years,with the continuous development of medical technology and the extensive application of invasive operation,the chances of infection have increased obviously by bacteria breaking through the barrier of human body.At the same time,all kinds of antimicrobial drugs,especially broad-spectrum antimicrobial drugs,make the bacteria resistant a large number of antimicrobial drug through a variety of regulatory mechanisms,which have caused great harm to the health and life of patients whether it is to increase the chances of infection,or pathogenic bacteria resistance significantly enhanced.ICU patients are critically ill,and most of them are under centralized management,which makes bacteria more likely to spread.Therefore,the investigation and analysis of the distribution of bacteria in ICU can provide a reliable basis for the prevention and treatment of infection.At the same time,it has practical significance to effectively prevent and control the emergence of bacterial drug resistance and further understand the transmission of pathogenic bacteria,drug sensitivity,drug resistance mechanism and high risk factors of pathogenic bacteria.In this study,patients,who have been infected by pathogens in the intensive care unit(ICU)of the first hospital of Lanzhou university from January 2010 to June 2018,were selected as the research objects to solve the following problems:(1)the distribution of pathogen infection in intensive care unit(ICU)of the hospital from January 2010 to June 2018;(2)the proportion of drug-resistant bacteria in the ICU and drug resistance situation;(3)the distribution and drug resistance situation of pseudomonas aeruginosa,and risk factors of Carbapenems Resistant Pseudomonas Aeruginosa.Aim to guide clinical treatment,reduce the hospital ICU infection multi-resistant bacteria,prevent the occurrence of hospital infection,control the spread of the pathogen,realize reasonable treatment and so on,and to provide the basis for the implementation of scientific and effective intervention measures.Methods: This study has chosen ICU patients with infection in our hospital between January2010 and June 2018 as the research object,investigated and collected the corresponding data,including patient's gender,age,medical condition,catheter indwelling,pathogenic bacteria,drugsensitive information.Results: 1.Gender : a total of 3,993 cases of pathogenic bacteria were collected by case review system and strictly screened with inclusion and exclusion criteria,including 2,885 cases(72.3%)of males and 1,108 cases(27.7%)of females.2.Age : the proportion of patients infected at the age of60-75 years old is the highest(31.9%),followed by greater than 75 years old(21.2%),and at the age of 30-50 years old(20.0%).3.Basic diseases: the most common basic diseases are chronic lung diseases(13.35%),cerebral hemorrhage(10.92%),trauma(10.04%),cardiovascular diseases(7.09%),and cerebral infarction(6.01%).4.Specimens for examination: the most important specimens for examination were sputum(55.60%),followed by blood(12.35%),sputum aspiration tube(12.02%),and venous catheter(5.46%).5.Clinical operation and surgery: a total of 33.76% of the patients had received puncture,31.76% had received surgery,and 18.18% had undergone tracheotomy.6.The main pathogens of infection in icu were G-(80.7%),fungi(10.5%),and G+(8.8%).7.G-separation rate and resistance : in G-separation rate from high to low were acinetobacter baumannii(41.5%),pseudomonas aeruginosa(15.4%),with klebsiella pneumoniae(15.2%),escherichia coli(9.1%),onion burkholderia bacteria(6.6%),eosinophilic malt narrow food(4.3%),sewer bacterium e.coli(4.1%),other gram-negative bacteria(3.9%).The drug resistance rates of acinetobacter baumannii(97.2%),e.coli(90.4%),klebsiella pneumoniae(70.0%)and pseudomonas aeruginosa(64.0%)were from high to low respectively.8.The separation rates of gram-positive bacteria were respectively staphylococcus aureus(38.7%),enterococcus fecal(34.3%),staphylococcus epidermidis(13.8%)and gram-positive bacteria(13.2%).The drug resistance rates were from high to low for staphylococcus epidermidis(91.7%),staphylococcus aureus(82.2%)and enterococcus feces(79.2%),respectively.9.The separation rates of candida albicans(44.8%),candida tropialis(23.1%),candida lucidum(16.7%),candida lucidum(8.3%)and other fungi(7.1%)were from high to low respectively.The drug resistance rates were from high to low for candida smooth(54.3%),candida tropical(50.5%)and candida albicans(19.1%),respectively.10.Year distribution: whether G-,G+ or fungi,the separation rate increased steadily from 2010 to 2014,decreased sharply in 2015,and then increased gradually again from 2016 to 2018.11.The drug resistance rate of pseudomonas aeruginosa to carbapenems reached 38.4%.12.Gender,the time of deep vein catheterization was performed,whether the primary disease was cardiovascular disease,cerebral hemorrhage,cerebral infarction and diabetes were independent risk factors for pseudomonas aeruginosa resistance to carbapenem.Conclusion: Among the infectious pathogens in ICU,acinetobacter baumannii dominated G-,staphylococcus aureus dominated G+,and candida albicans dominated fungi.The highest drugresistance rates were acinetobacter baumannii,staphylococcus epidermidis and candida smooth.Over30% of pseudomonas aeruginosa resistant to carbapenems;Gender,time of deep venous catheterization,whether the primary disease is cardiovascular disease,cerebral hemorrhage,cerebral infarction and diabetes are independent risk factors for patients infected with carbapenem resistant pseudomonas aeruginosa.