重症监护病房耐美罗培南铜绿假单胞菌感染的危险因素分析及干预对策

Analysis of Risk Factors and Intervention Measures of Meropenem-resistant Pseudomonas Aeruginosa Infection in Intensive Care Unit

目的探讨重症监护病房耐美罗培南铜绿假单胞菌感染的危险因素并制定相应干预对策。方法选择四川省达州市中心医院重症监护病房2013年1月—2016年10月感染耐美罗培南铜绿假单胞菌的40例作为研究组,并选择同期未感染耐美罗培南铜绿假单胞菌的40例作为对照组。记录2组年龄、机械通气时间、合并基础性疾病、入住重症监护病房时间、免疫抑制剂应用时间及经验性使用碳青霉烯类抗菌药物情况等并进行危险因素分析。结果机械通气时间≥1周、入住重症监护病房时间≥1周、有经验性应用碳青霉烯类抗菌药物是重症监护病房感染耐美罗培南铜绿假单胞菌的独立危险因素(P<0.05)。结论在重症监护病房对于需要给予抗生素治疗的患者,应当早期行细菌学检查确定致病菌,降低经验性应用碳青霉烯类抗菌药物的频率,缩短患者机械通气治疗时间,可降低耐美罗培南铜绿假单胞菌的感染率。

Objective To analyze risk factors of Meropenem-resistant pseudomonas aeruginosa infection in inten-sive care unit （ ICU） and to establish corresponding intervention measures. Methods Clinical data of 40 patients, who were infected with Meropenem-resistant pseudomonas aeruginosa during January 2013 and October 2016, was retrospec-tively analyzed. The 40 patients were used as research group, and other 40 patients without Meropenem-resistant pseudo-monas aeruginosa infection were selected as control group. Conditions such as age, mechanical ventilation time, com-bined with basic diseases, ICU stay time, the time of immunosuppressant application and empirical use condition of car-bapenem antibiotics were recorded, and risk factors were analyzed in two groups. Results There were significant differ-ences in mechanical ventilation time, ICU stay time and empirical use condition of carbapenem antibiotics between the two groups （P〈0. 05）. Mechanical ventilation time equal or more than 1 week, ICU stay time equal or more than 1 week and having empirical application of carbapenem antibiotics were independent risk factors of Meropenem-resistant pseudo-monas aeruginosa infection in ICU （P〈0. 05）. Conclusion Patients need antibiotic treatment in ICU, and the patho-gen should be identified as possible as early by bacteriological examination, and the disinfection and isolation for ICU should be enhanced, and the frequency of empirical application of carbapenem antibiotics should be reduced, and also re-ducing the mechanical ventilation time should be decreased, and then the infection rate of Meropenem-resistant pseudo-monas aeruginosa infection can be decreased.