对碳青霉烯耐药或不耐药的铜绿假单胞菌多药耐药情况与相关因素分析

Multi-drug Resistance of Pseudomonas Aeruginosa Resistant or Sensitive to Carbapenem and an Analysis of Correlated Factors

目的分析对碳青霉烯耐药或不耐药的铜绿假单胞菌的多药耐药情况,并探讨其相关因素。方法收集确诊为医院获得性肺炎并培养出铜绿假单胞菌的呼吸道分泌物标本共180例,分为耐碳青霉烯组和非耐碳青霉烯组各90例,分析比较两组菌株对多种抗菌药耐药情况及患者临床状况。结果当铜绿假单胞菌对碳青霉烯药物出现耐药后,对其他多种抗菌药耐药率均明显上升,且易出现多药耐药。经单因素相关分析发现,铜绿假单胞菌对碳青霉烯耐药的危险因素包括:高龄、有慢性阻塞性肺疾病(COPD)/支气管扩张的基础病、急性生理功能和慢性健康状况评分系统(APACHE)Ⅱ评分高、机械通气、并发2种或2种以上细菌的混合感染以及分离出铜绿假单胞菌前15 d接受氟喹喏酮、第3代头孢菌素、亚胺培南/美罗培南治疗等。多因素回归分析发现,机械通气以及分离出致病菌前15 d接受亚胺培南/美罗培南治疗是独立危险因素。结论铜绿假单胞菌对碳青霉烯耐药的原因较复杂,可能与宿主基础状态、感染程度和抗菌药的使用有关,而且当铜绿假单胞菌对碳青霉烯产生耐药时,往往预示着可能对其他多种抗菌药出现耐药。

Objective To study the multi-drug resistance of Pseudomonas aeruginosa resistant or sensitive to earbapenem and to analyze correlated factors. Methods Specimens of respiratozT tract secretions collected from 180 patients with confirmed diagnosis of nosocomial infection with Pseudomonas aeruginosa（PA） were demonstrated by culture in our hospital laboratory to be positive for the bacteria . PA from 90 of the specimens was resistant while that of the other 90 of specimers was sensitive to carbapenem. The bacteria both resistant and sensitive to carbapenen were subjected to an assay of drug resistance to many kinds of antibiotics. The results and the clinical situation of the patients were compared and analyzed. Results Pseudomonas aeruginosa proved resistant to carbapenem was shown to have a strikingly increased rate of tolerance to many other antibiotics and was more liable to develop multi-drug resistance. Single factor correlation analysis revealed that the risk factors of PA to be resistant to carbapenem included advanced age,underlying sickness such as chronic obstructive pulmonazy disease/ bror, chiectasis ,high scoring in （APACHE） 1I, mixed infection with 2 or lnore kinds of bactesia, treatment with fluoroquinolone and imipenem/ meropenem 15 days before the isolation of PA, etc. It was shown by multiple factor regression analysis that mechanical ventilation and treatment with imipenem/meropenem 15 days before the isolation of PA were the 2 independent risk factors. Conclusion The reason for Pseudomonas aeruginosa to be drug-resistant to carbapenem seemed rather complicated. It may be related to the basic condition of the patient , severeity of infection and the use of antibiotics. Drug-resistance of Pseudomonas aeruginosa to carbapenem frequently forbodes the possibility of its tolerance to many other antibiotics.