泛耐药铜绿假单胞菌、鲍曼不动杆菌感染的高危因素及预防对策

Clinical Study of Pan-drug Resistant Pseudomonas Aeruginosa and Acinetobacter Baumannii

目的:分析泛耐药铜绿假单胞菌(PDR-Pa)和泛耐药鲍曼不动杆菌(PDR-Ab)感染病例发生泛耐药的危险因素,为临床预防抗生素诱导耐药,减少泛耐药的发生提供依据和指导。方法:收集我院2009年9月～2010年1月临床分离的PDR-Pa菌株21株和PDR-Ab菌株20株的感染病例,回顾性分析相应病例的临床资料。结果:21例PDR-Pa感染的病例,先期均使用了抗生素,平均时间为30.0±21.4天,12例使用了碳青霉烯类药物,15例使用了氟喹诺酮类药物,平均时间分别为8.8±5.3天、12.7±9.7天;11例使用了呼吸机。20例PDR-Ab感染的病例,先期均使用了抗生素,平均时间为28.0±18.9天,有9例使用了碳青霉烯类药物,11例使用了氟喹诺酮类药物,平均时间分别为8.4±5.6天、10.2±9.5;14例使用了呼吸机。结论:先期长期抗生素的使用、碳青霉烯类和氟喹诺酮类药物的诱导、呼吸机的使用可能是泛耐药株发生的高危因素。

Objective Analysing the releated cases with pan-drug resistance pseudomonas aeruginosa(PDR-Pa) and pan-drug resistance acinetobacter baumannii(PDR-Ab) infection to provide experimental evidence and guidance,explore the possible risk factors of pan-drug resistance to prevent resistance that inducted by antibiotics and reinforce the control measures of the infection,in order to reduce the incidence of pan-resistant.Methods 21 strains isolated of PDR-Pa and 20 strains isolated of PDR-Ab were collected from the hospital in September 2009 to January 2010.The clinical data of these patients were reviewed retrospectively and analyzed statistically.Results Antiobictics were used in advance in 21 impatients with PDR-Pa infection and the mean lasting time was 30.0±21.4 days,in 12 of which carbapenems antibiotics and Fluoroquinolone were used and the mean lasting time was 8.8±5.3 and 12.7±9.7 days,in 11 of which respiratory accumulator was used.Antiobictics were used in advance in 20 impatients with PDR-Ab infection and the mean lasting time was 28.0±18.9 days,in 9 of which carbapenems antibiotics were used and the mean lasting time was8.4±5.6 days,in 11 of which Fluoroquinolonein was used and 10.2±9.5,in 14 of which respiratory accumulator was used.Conclusion Prolonged use of antibiotics in advance,the induction of carbapenems and fluoroquinolones and the application of ventilator are the possible risk factors of pan-drug resistance.