某“三甲”肿瘤医院住院患者并发耐碳青霉烯铜绿假单胞菌感染的流行病学特点与危险因素分析

Analysis of Epidemiological Characteristics and Risk Factors of Complicated CRPA Infections in Inpatients in a "Grade A Class 3" Tumor Hospital

目的:分析某“三甲”肿瘤医院住院患者并发耐碳青霉烯铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa,CRPA)感染的流行病学特点与危险因素,为CRPA感染的防治提供参考。方法:选取2018年—2020年南通市肿瘤医院收治的160例铜绿假单胞菌感染患者的病历资料,根据是否对碳青霉烯类药物耐药将其分为CRPA感染组(n=80)和非CRPA感染组(n=80),分析患者发生CRPA感染的历年趋势、标本来源和科室分布,以及相关危险因素。结果:三年间,2019年CRPA的检出最多(38株,占47.50%),2020年的检出最少(13株,占16.25%);CRPA的标本来源主要为痰液(48株,占60.00%),其次为胆汁(9株,占11.25%);在科室分布方面,CRPA主要检出自ICU(18株,占22.25%)和呼吸内科(16株,占20.00%);回归分析结果显示,住院时间、合并其他病原菌感染、抗菌药物联用品种数、抗菌药物使用疗程,以及留置深静脉导管、导尿管、引流管与患者发生CRPA感染具有相关性(P<0.05),其中抗菌药物联用品种数≥3、抗菌药物使用疗程≥14 d和合并其他病原菌感染是患者发生CRPA的独立危险因素(P<0.05)。结论:CRPA主要检出自痰液,而其感染主要发生在ICU和呼吸内科;抗菌药物联用品种数≥3、抗菌药物使用疗程≥14 d和合并其他病原菌感染是患者发生CRPA的独立危险因素,对此临床应加强抗菌药物的管理,规范抗菌药物的使用,以遏制或减少CRPA感染的发生。

Objective:To investigate the epidemiological characteristics and risk factors of complicated carbapenemresistant Pseudomonas aeruginosa(CRPA)infections in inpatients in a"Grade A Class 3"tumor hospital,and to provide reference for the prevention and treatment of CRPA infection.Methods:The medical records of 160 patients with Pseudomonas aeruginosa infection admitted to Nantong Tumor Hospital from 2018 to 2020 were selected,and they were divided into CRPA-infected group(n=80)and non-CRPA-infected group(n=80)according to whether they were resistant to carbapenems.The historical trends,specimen sources,departmental distribution of patients with CRPA infection and related risk factors were analyzed.Results:During the three years,CRPA was most detected in 2019(38 strains,accounting for 47.50%)and least detected in 2020(13 strains,accounting for 16.25%);the CRPA specimens were mainly detected from sputum(48 strains,accounting for 60.00%),followed by bile(9 strains,accounting for 11.25%);in terms of departmental distribution,CRPA was mainly detected in the ICU(18 strains,accounting for 22.25%)and the Respiratory Department(16 strains,accounting for 20.00%).The regression analysis results showed that the length of hospital stay,the complication of other pathogenic infections,the number of varieties of combined antibacterials,the use course of antibacterials,and the indwelling deep venous catheter,urethral catheter and drainage tube were related to CRPA infections in patients(P<0.05),among which the number of varieties of combined antibacterials greater than or equal to3,the use course of antibacterials longer than or equal to 14d,and the complication of other pathogenic infections were independent risk factors of CRPA in patients(P<0.05).Conclusion:CRPA is mainly detected in sputum,and its infection mainly occurs in ICU and Respiratory Department.The number of varieties of combined antibacterials greater than or equal to 3,the use course of antibacterials longer than or equal to 14 d and the complication of other pathogenic infections are independent risk factors of CRPA in patients,so the management of antibacterials should be clinically enhanced and the use of antibacterials should be regulated,to eradicate or reduce the CRPA infection.