联合用药对铜绿假单胞菌耐药性的影响

Analysis of the relationship factors caused by pseudomonas aeruginosa in hospital

目的:探讨抗生素及其他药物的使用对铜绿假单胞菌耐药性的影响,以及预防和延缓耐药菌产生的方法,为临床早期制定治疗方案、合理应用抗生素提供依据。方法:以2004年1月1日—2005年12月31日本院细菌室培养分离出的129株铜绿假单胞菌作为本次研究对象,对分离出耐药菌的患者用药情况做跟踪调查,用SPSS 10.0进行统计学分析,χ2检验比较各组间率的差异。结果:铜绿假单胞菌耐首选抗生素头孢他啶(CAZ)、环丙沙星(CIP)和亚胺培南-西司他丁(IPM)的共同影响因素为,抗生素使用时间≥4周及抗生素使用不合理;近期有抗生素治疗史是铜绿假单胞菌耐CAZ的影响因素之一(P<0.05),而分离出致病菌前2周接受第三代头孢菌素、喹诺酮类、氨基糖苷类和抑酸剂的使用是铜绿假单胞菌耐CAZ、CIP的共同影响因素(P<0.05);耐CAZ的其他因素还包括大环内酯类的使用、糖皮质激素的使用(P<0.05);另外铜绿假单胞菌对IPM耐药的影响因素还包括分离出致病菌前2周接受泰能(P<0.05),铜绿假单胞菌耐CIP的另外影响因素有中草药的使用。结论:联合用药对铜绿假单胞菌耐CAZ、CIP、IPM的影响因素不尽相同,对耐CAZ、CIP的影响较大,而对耐IPM影响较小,因而铜绿假单孢菌感染的危重患者以首选IPM治疗为最佳方案。因本院为中医院,中草药大量使用是降低耐药率的有利因素。

OBJECTIVE To analyze the relationship factors caused by the usage of the antibiotics and other drugs to resistant strains in hospital, to provide valuable proofs for constituting Rx and reduce the incidence of infection. SUBJECTS We test 129 strains resistant Bacteria were isolated at our hospital from January 1st 2004 to December 31st 2005. METHODS SPSS 10.0, odds ratios and stepwise Logistic regression analysis were used to determine the interrelationships between multiple variables. Statistical significance was predetermined to include Pvalues of 〈 0.05. RESULTS The following factors were significantly （ P 〈 0.05 ） associated with Pseudomonas aeruginosa resist to CAZ,CIP,such as antibiotics usage I≥4 weeks and etc. Using Chinese herb medicine was a protective factor. CONCLUSION Relationship factors caused by resistant strains are different. IPM should be used firstly to serious patient and Chinese herb medicine is a protective factor.