ICU患者发生耐碳青霉烯褪色沙雷菌肺炎的相关因素分析

Related factors for carbapenem-resistant Serratia marcescens pneumonia in ICU patients

目的探讨重症监护室患者发生耐碳青霉烯褪色沙雷菌肺炎的相关因素,为临床诊断和治疗提供参考依据。方法回顾性调查医院2012年7月-2017年6月重症监护室内耐碳青霉烯类褪色沙雷菌肺炎患者47例,分析其发生的相关因素。结果入住ICU时间、有创机械通气时间、应用碳青霉烯类抗菌药物、应用双联抗菌药物、抗菌药物应用≥3联、抗菌药物应用时间≥14d、气管切开、机械通气、纤维支气管镜检查及治疗、有创操作≥3项与耐碳青霉烯褪色沙雷菌肺炎有关(P<0.05)。Logistic回归分析发现,应用碳青霉烯类抗菌药物、纤维支气管镜检查及治疗、抗菌药物应用≥3联为独立相关因素。结论耐碳青霉烯褪色沙雷菌肺炎与多项相关因素相关;合理应用抗菌药物、科学管理侵袭性操作将有利于减少耐碳青霉烯褪色沙雷菌肺炎的发生。

OBJECTIVE To explore the related factors for carbapenem-resistant Serratia marcescens pneumonia in patients of intensive care unit（ICU）so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 47 patients with carbapenem-resistant S.marcescens pneumonia who were treated in ICU from Jul 2012 to Jun 2017 were retrospectively investigated,and the related factors were analyzed.RESULTS The carbapenem-resistant S.marcescens pneumonia was associated with length of ICU stay,mechanical ventilation duration,use of carbapenems,two-drug therapy,no less than three-drug therapy,time of use of antibiotics no less than 14 days,tracheotomy,mechnical ventilation,fiberoptic bronchoscopy and treatment and no less than 3 types of invasive operations（P〈0.05）.Logistic regression analysis indicated that the use of carbapenems,fiberoptic bronchoscopy and treatment and no less than three-drug therapy were the independent related factors.CONCLUSIONThere are a variety of related factors for the carbapenem-resistant S.marcescens pneumonia.The reasonable use of antibiotics and scientific management of invasive operations may reduce the incidence of the carbapenem-resistant S.marcescens pneumonia.