PICU多重耐药铜绿假单胞菌感染的临床特点及耐药性分析

Clinical characteristic and drug resistance analysis of PICU multiple drug resistant pseudomonas aeruginosa infection

目的通过对多重耐药铜绿假单胞菌感染的高危因素及耐药性分析,总结PICU产生多重耐药铜绿假单胞菌感染的原因,指导临床诊疗。方法选择2010~2015年我院PICU多重耐药铜绿假单胞菌感染的患儿43例作为研究组,同期非多重耐药铜绿假单胞菌感染的患儿35例作为对照组,采用回顾性研究,对是否长时间联合使用广谱抗生素、ICU入住时间、是否机械通气、机械通气时间、是否中心静脉置管、中心静脉置管时间及有无基础疾病、严重并发症等高危因素及对多重耐药铜绿假单胞菌感染的耐药情况进行分析。结果研究组与对照组相比,联合使用广谱抗生素〉1w（40例vs.4例）、ICU入住时间〉2w（41例vs.18例）、机械通气（29例vs.11例）、机械通气时间〉1w（20例vs.2例）、中心静脉置管（21例vs.3例）、中心静脉置管时间〉1w（10例vs.1例）,营养不良（31例vs.10例）、存在复杂先天性心脏病（29例vs.8例）、先天/继发性免疫缺陷（20例vs.2例）、精神运动发育迟滞（15例vs.3例）合并2种以上严重并发症（18例vs.5例）均较对照组明显增加,差异具有统计学意义（P〈0.05）;多重耐药铜绿假单胞菌对常见的抗假单胞菌的头孢菌素类、哌拉西林三唑巴坦、碳青霉烯类的敏感性呈下降趋势,仅对喹诺酮类、氨基糖苷类、四环素类仍保持着较高的敏感率。结论联合使用广谱抗生素、ICU入住时间〉2w、机械通气及持续时间〉1w、中心静脉置管及持续时间〉1w、合并基础疾病及严重并发症等均是多重耐药铜绿假单胞菌感染的高危因素;经验性选择联合用药是治疗的基本措施。

Objective To study risk factors of multiple drug resistance pseudomonas aeruginosa（MDR-PA） infection,analyze drug resistance and guide the clinical diagnosis and treatment.Methods f43 cases with MDR-PA infection hospitalized in PICU from 2010 to2015 were chosen as study group.In the same period,35 cases with non MDR-PA infection were chosen as control group.Retrospective study was done between two groups.Combined use of broad-spectrum antibiotics or not,ICU stay time,giving mechanical ventilation or not,mechanical ventilation time,having central venous catheter or not and also stay time,basic diseases risk factors and drug resistance of multiple drug resistance of PA infection were analyzed.Results Compared with control group,in study group,Combined use of broad spectrum antibiotics〉1 w（40 cases vs.4 cases）,ICU stay time〉2 w（18 cases vs.41 cases）,mechanical ventilation（29 cases vs.11cases）,mechanical ventilation time〉1 w（20 cases） vs.2 cases）,central venous catheter（21 cases vs.3 cases）,central venous catheter time〉1 w（10 cases vs.1 case）,malnutrition（31 cases） vs.10 cases）,there are complex congenital heart disease（29 cases vs.8 cases）,congenital/secondary immunodeficiency（20 cases） vs.2 cases）,psychomotor retardation（15 cases vs.3 cases） combined with two or more serious complications（18 vs.5） increased significantly than those in control group,the difference has statistical significance（P〈0.05）.Sensitivity of MDR-PA to pseudomonas cephalosporin,piperacillin tazobactam and carbapenems declined,but it had a high sensitive rate for quinolone and aminoglycoside,tetracycline.Conclusion Combined antibiotics use,malnutrition,congenital heart disease,ICU stay time〉2 w,mechanical ventilation and mechanical ventilation time〉1 w,center venipuncture and venipuncture time〉1 w,having basic diseases and serious complications are risk factors of MDR-PA infection;It is basic measure of treatment to choose and combine with sensitive drugs.