机械通气的严重胸外伤患者铜绿假单胞菌感染的流行病学和危险因素分析

Epidemiology and risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma and mechanical ventilation

目的铜绿假单胞菌逐渐成为院内感染的主要菌株,且耐药性较高。本文旨在探讨机械通气的严重胸外伤患者铜绿假单胞菌感染的流行病学和危险因素,为临床上防治机械通气相关性铜绿假单胞菌感染提供依据。方法前瞻性收集2012年1月—2016年1月温州医科大学附属第五医院收治的机械通气的严重胸外伤患者218例,主要观察指标为铜绿假单胞菌感染的流行病学和危险因素,次要观察指标为铜绿假单胞菌的耐药性。结果共21例(9.63%)患者发生铜绿假单胞菌感染,在机械通气后3~47 d确诊,平均在机械通气后(19.57±7.38)d确诊为铜绿假单胞菌感染。与对照组比较,研究组患者机械通气时间显著延长、开放性损伤率、APACHEⅡ评分、抗菌素使用种类≥3种率、开胸手术率、血气胸发生率和多发伤率显著增高(P<0.05)。单因素和多因素回归分析显示机械通气时间、APACHEⅡ评分和开胸手术是机械通气的严重胸外伤患者铜绿假单胞菌感染的危险因素(P<0.05)。21株铜绿假单胞菌中,18例为多重耐药菌,2例为泛耐药菌,对亚胺培南和美罗培南耐药率较低(14.29%)。结论机械通气的严重胸外伤患者铜绿假单胞菌感染率和耐药性较高,机械通气时间、APACHEⅡ评分和开胸手术是机械通气的严重胸外伤患者铜绿假单胞菌感染的危险因素,对这类患者加强铜绿假单胞菌的防治或可改善临床预后。

Objective Pseudomonas aeruginosa is the main strain of nosocomial infection with a high drug resistance. The aim of this paper is to investigate the epidemiology and risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma and mechanical ventilation, so as to provide basis for clinical prevention and treatment of ventilator- associated Pseudomonas aeruginosa. Methods Total 218 patients with severe chest trauma and mechanical ventilation in our hospital from January,2012 to January,2016 were prospectively collected. The primary outcomes included the epide- miology and risk factors of Pseudomonas aeruginosa infection, and the secondly outcomes included drug resistance of Pseudomonas aeruginosa. Results A total of 21 cases （9.63 % ） developed Pseudomonas aeruginosa infection. The diag- nosis was confirmed at 3 to 47 days after mechanical ventilation, and the average infection days was （ 19.57 ± 6.38 ） days after mechanical ventilation. When compared with the control group, patients in the study group got a significantly longer duration of mechanical ventilation,a higher rate of open injury,a higher level of APACHE II score,a higher rate of more than 3 kinds of antibiotics usage, a higher rate of thoracotomy, a higher rate of hematopneumothorax and a higher rate of muhiple injuries （P 〈 0.05 ）. Single factor and muhi factor regression analysis showed that the duration of mechanical ven- tilation, APACHE score and thoracic surgery were risk factors of Pseudomonas aeruginosa infection in severe thoracic trau- ma patients with mechanical ventilation（ P 〈 0.05 ）. In the 21 strains of Pseudomonas aeruginosa, 18 strains were multi- drug resistant bacteria,2 strains were extensively drug resistant bacteria. The drug resistance rate of Pseudomonas aerugi- nosa resistant to imipenem and meropenem were lower（ 14.29% ）. Conclusion The Pseudomonas aeruginosa infection rate and drug resistance rate in patients with severe thoracic trauma and mechanical ventilation are high, and duration of mechanical ventilation, APACHE score and thoracic surgery were risk factors of Pseudomonas aeruginosa infection in se- vere thoracic trauma patients with mechanical ventilation. The prevention and treatment of this type of Psendomonas aerug- inosa may improve patients＇ outcomes.