ICU多重耐药菌感染的风险因素分析及护理预防策略研究

Analysis of Risk Factors and Nursing Prevention Strategies for ICU Multidrug-Resistant Bacterial Infections

摘要: 目的：探讨ICU多重耐药菌(MDRO)感染的发生特点及其主要风险因素，并基于研究结果构建可操作性的护理预防策略体系，以降低感染发生率、改善重症患者预后。方法：采用回顾性研究方法，收集某三甲医院ICU 2022年1月至2023年12月期间432例患者的临床资料，包括人口学特征、基础疾病、侵入性操作、抗菌药物暴露及病原菌培养结果。通过单因素比较和多因素Logistic回归分析识别独立危险因素，并结合临床护理流程构建预防策略。结果：ICU MDRO感染发生率为29.17%。单因素分析显示年龄、APACHE II评分、机械通气时间、中心静脉置管时间、碳青霉烯类抗生素使用时长及肾功能不全等指标在感染组显著更高。多因素分析表明APACHE II评分(OR = 1.087)、机械通气时间(OR = 1.120)、中心静脉置管时间(OR = 1.102)、碳青霉烯类暴露时间(OR = 1.135)及肾功能不全(OR = 2.389)为独立危险因素。结论：ICU MDRO感染受疾病严重程度、侵入性操作及抗菌药物管理等多重因素影响。构建系统化的护理策略，包括风险评估、操作流程优化、抗菌药物管理及环境控制，可有效降低耐药菌感染风险，提高ICU护理质量与患者生存率。

Abstract: Object: To explore the characteristics and main risk factors of multidrug-resistant bacterial (MDRO) infection in ICU, and to construct an operable nursing prevention strategy system based on the research results, in order to reduce the incidence of infection and improve the prognosis of critically ill patients. Method: A retrospective study was conducted to collect clinical data of 432 patients in the ICU of a tertiary hospital from January 2022 to December 2023, including demographic characteristics, underlying diseases, invasive procedures, antibiotic exposure, and pathogen culture results. Identify independent risk factors through univariate comparison and multivariate logistic regression analysis, and construct prevention strategies in combination with clinical nursing processes. Result: The incidence of MDRO infection in ICU was 29.17%. Univariate analysis showed that age, APACHE II score, mechanical ventilation time, central venous catheterization time, duration of carbapenem antibiotic use, and renal dysfunction were significantly higher in the infection group. Multivariate analysis showed that APACHE II score (OR = 1.087), mechanical ventilation time (OR = 1.120), central venous catheterization time (OR = 1.102), carbapenem exposure time (OR = 1.135), and renal dysfunction (OR = 2.389) were independent risk factors. Conclusion: ICU MDRO infection is influenced by multiple factors such as disease severity, invasive procedures, and antibiotic management. Building a systematic nursing strategy, including risk assessment, operational process optimization, antibiotic management, and environmental control, can effectively reduce the risk of drug-resistant bacterial infections and improve the quality of ICU nursing and patient survival rate.