耐多药铜绿假单胞菌感染临床特征及相关因素分析

Clinical features and risk factors for infections of multi-drug resistant Pseudomonas aeruginosa

目的研究耐多药铜绿假单胞菌感染的临床特征、预后与相关因素。方法回顾性分析2013年2月-2018年1月医院耐多药铜绿假单胞菌感染患者213例为研究对象,采用1∶4病例-对照研究,纳入852例非耐多药铜绿假单胞菌感染患者,分析患者临床资料,归纳耐多药铜绿假单胞菌感染的相关因素。结果耐多药铜绿假单胞菌以呼吸道感染为主,主要分布在ICU和神经外科;机械通气、入住ICU、氨基糖苷类、3~4代头孢菌素、碳青霉烯类、多药联类、培养前经验使用抗菌药物是耐碳青霉烯类铜绿假单胞菌感染的相关因素(P<0.05),耐多药铜绿假单胞菌组治疗有效率为68.54%(146/213)低于非耐多药铜绿假单胞菌组89.91%(766/852),且两组患者疗效差异有统计学意义(P<0.001)。结论耐多药铜绿假单胞菌感染率高,预后较差;临床应减少不必要机械通气与入住ICU,提高微生物培养送检率,尽量减少经验使用抗菌药物,根据培养与药敏试验结果合理使用抗菌药物,减少耐多药铜绿假单胞菌感染,提高疗效。

OBJECTIVE To investigate the clinical features,prognosis and risk factors of multi-drug resistant Pseudomonas aeruginosa infection.METHODS A retrospective analysis of 213 cases of multi-drug resistant P.aeruginosainfection in hospital from Feb.2013 to Jan.2018 was conducted.The 1：4 case control study was used to include 852 cases of non multi-drug resistant P.aeruginosainfection,the clinical data of patients were analyzed,and the related factors of multi-drug resistant P.aeruginosainfection were summed up.RESULTS multi-drug resistant P.aeruginosa was mainly respiratory infection,mainly in ICU and department of neurosurgery.Mechanical ventilation,ICU,aminoglycoside,3~4 generation cephalosporin,carbapenems,multidrug combination,and antimicrobial agents used before culture were related factors of carbapenem-resistant P.aeruginosainfection（P〈0.05）.The treatment efficiency of multi-drug resistant P.aeruginosa was 68.54%（146/213）,which was significantly lower than 89.91%（766/852）of the non multi-drug resistant P.aeruginosa group（P〈0.001）.CONCLUSIONThe infection rate of multi-drug resistant P.aeruginosais high and the prognosis is poor.It should reduce the unnecessary mechanical ventilation and ICU,improve the rate of microbial culture,reduce the use of antimicrobial agents as far as possible,and rationally use antimicrobial agents according to the results of culture and drug sensitivity tests,so as to reduce the infection of multi-drug resistant P.aeruginosa,and improve the curative effect.