耐碳青霉烯类铜绿假单胞菌感染患者的临床特点与预后分析

Clinical characteristics and prognosis of patients with carbapenemresistant Pseudomonas aeruginosainfection

目的分析耐碳青霉烯类铜绿假单胞菌(CRAB)感染患者的临床特点及预后,为临床抗菌药物应用提供参考依据。方法选择2011年5月-2014年5月于医院经细菌培养鉴定为铜绿假单胞菌感染的71例患者,采用K-B纸片扩散法进行药敏试验,记录两组患者的病死率,转入ICU后住院天数及辅助呼吸机机械通气天数,数据采用SPSS 13.0软件进行统计分析。结果 71例患者共检出100株铜绿假单胞菌,其中痰液中分离出的最多占56.00%,其次为引流液占24.00%;检出CRAB 32株,占32.00%,检出非CRAB 68株,占68.00%;CRAB与非CRAB对阿米卡星、多黏菌素、环丙沙星均较敏感;非CRAB感染患者病死率为1.79%,CRAB感染患者病死率为13.33%,两组患者的病死率比较差异有统计学意义(P<0.05);非CRAB感染患者转入ICU后住院天数及机械通气天数也显著少于CRAB感染患者,差异有统计学意义(P<0.05)。结论铜绿假单胞菌以呼吸道检出最为常见,部分存在较严重的耐碳青霉烯类抗菌药物,耐药患者多预后不佳,临床应及早发现正确用药。

OBJECTIVE To investigate the clinical characteristics and prognosis of the patients with carbapenem-resistant Pseudomonas aeruginosa infection so as to provide guidance for clini（al use of antibiotics. METHODS From May 2011 to May 2014, a total of 71 patients who were conformed as the P. aeruginosa infection through the bacterial culture were enrolled in the study, then the drug susceptibility testing was carried out by using K-B disk diffusion method, the mortality rates, length of ICU stay, and mechanical ventilation duration were recorded, and the statistical analysis was performed with the use of SPSS 13.0 software. RESULTS Totally 100 strains of P. aeruginosa were isolated from the 71 patients, of which 56. 00% were isolated from sputum specimens, and 24.00% were isolated from drainage fluid. There were 32 （32.00%） strains of CRAB and 68 （68.00%） strains of non-CRAB. The CRAB and non-CRAB strains were susceptible to amikacin, polymyxin, and ciprofloxacin. The mortality rate was 1.79 % in the patients with non-CRAB infection, 13.33%in the patients with CRAB infection, and there was significant difference in the mortality rate between the two groups of patients （P〈0. 05）. The length of ICU stay and mechanical ventilation duration of the patients with non-CRAB infection were significantly shorter than those of the patients with CRAB infection, and there was significant difference （P〈0. 05）. CONCLUSION The P. aeruginosa strains are most commonly detected in the respiratory tract, some of which are highly resistant to carbapenems. The prognosis of most of the patients is poor, and it is necessary for the hospital to reasonably use antibiotics.