耐碳青霉烯类铜绿假单胞菌肺炎耐药性及危险因素分析

Analysis of drug resistance and risk factors of pneumonia caused by carbapenem-resistant Pseudomonas aeruginosa

目的探讨耐碳青霉烯类铜绿假单胞菌(IMPRPAE)肺炎耐药性和危险因素,为防治耐碳青霉烯类铜绿假单胞菌肺炎提供理论依据。方法收集2016年1月-12月本院82例耐碳青霉烯类铜绿假单胞菌(IMPRPAE)住院感染肺炎患者资料和菌株为实验组、82例碳青霉烯类敏感铜绿假单胞菌(IMPSPAE)住院感染肺炎患者资料和菌株为对照组,用Carba NP方法检测碳青霉烯酶,分析危险因素和耐药性。结果实验组对抗生素的耐药性显著高于对照组,差异有统计学意义(P<0.01)。ICU入住、呼吸机使用、气管插管、碳青霉烯类药物使用、年龄因素、住院天数、抗生素使用时间2组比较差异有统计学意义(P<0.05);呼吸机使用、气管插管、碳青霉烯类药物使用、住院天数(≥14 d)、ICU入住是IMPRPAE肺炎的独立危险因素。结论 IMPRPAE耐药严重,因此,合理使用抗菌药物、减少呼吸机使用、减少气管插管、减少碳青霉烯类药物使用是预防和控制IMPRPAE肺炎的关键。

Objective To investigate the risk factors for pneumonia caused by carbapenem-resistant Pseudomonas aeruginosa（ IMPRPAE） and drug-resistance of IMRPAE in order to provide evidences for clinical prevention and treatment of pneumonia caused by IMPRPAE. Methods From January 1 to December 31 in 2016,eighty-two patients with IMPPRAE-infected pneumonia were enrolled in the experience group and 82 patients with sensitive IMPSPAE pneumonia were used as control group. Carbapenemase was detected by Carba NP method to analyze risk factors and drug resistance. Results The resistance of the experimental group to antibiotics was significantly higher than that of the control group,and the difference was statistically significant（ P〈 0. 01）. And there was statistical significance on the differences of days of ICU,ventilator,endotracheal intubation,use of carbapenems,age,the days of hospitalization,use of antibiotic between the two groups（ P〈 0. 05）. Ventilator,endotracheal intubation,use of carbapenems,the days of hospitalization（ ≥14 d）,the days of ICU were independent risk factors for pneumonia caused by IMPRPEA. Conclusion The resistance of IMPRPEA is critical,rational use of antibiotic,reducing ventilator,reducing endotracheal intubation,reducing use of carbapenems are the keys to prevent and control pneumonia caused by IMPRPEA.