碳青霉烯类抗生素暴露对老年重症肺炎多重耐药菌检出率及预后的影响

Effect of carbapenem exposure on isolation rate of multidrug-resistant organisms and prognosis of elderly patients with severe pneumonia

目的探讨碳青霉烯类抗生素暴露对老年重症肺炎多重耐药菌(MDRO)检出率及预后的影响。方法回顾性调查2014年2月—2016年2月某院重症医学科收治的老年重症肺炎患者。根据是否存在碳青霉烯类抗生素暴露分为A组(碳青霉烯暴露组)、B组(非碳青霉烯暴露组)。A组患者再依据碳青霉烯类抗生素暴露时间分为2个亚组,A1组:应用碳青霉烯类抗生素时间>7 d的患者;A2组:应用碳青霉烯类抗生素时间≤7 d的患者。对各组患者MDRO检出率、机械通气日数、入住ICU日数及28 d病死率进行比较分析。结果共纳入患者86例,其中男性57例,女性29例;年龄65~92岁,平均年龄(80.12±10.45)岁。A组40例,B组46例;A1组24例,A2组16例。A组MDRO检出率为65.00%,B组为36.96%,差异有统计学意义(P<0.05);两组患者比较,A组的机械通气日数、入住ICU日数、28 d病死率均高于B组,差异均具有统计学意义(均P<0.05)。A1组的MDRO检出率为75.00%,高于A2组的43.75%(P<0.05);A1组的机械通气日数为(7.69±2.22)d,高于A2组的(6.34±1.56)d(P<0.05);A1、A2组28 d病死率及入住ICU日数比较,差异均无统计学意义(均P>0.05)。结论碳青霉烯类抗生素暴露可增加MDRO感染的发生,特别是非发酵菌的定植或感染,且延长了患者机械通气日数及入住ICU日数,影响患者预后。

ObjectiveTo evaluate the effect of carbapenem exposure on isolation rate of multidrug resistant organisms(MDROs)and prognosis of elderly patients with severe pneumonia.MethodsElderly patients with severe pneumonia and admitted to the intensive care unit in a hospital between February2014and February2016were investigated retrospectively.According to whether there was carbapenem exposure,patients were divided into group A(carbapenem exposure group)and group B(carbapenem non exposure group).Patients in group A were subdivided into two subgroups according to exposure time of carbapenems,group A1received carbapenems for>7days,group A2received carbapenems for≤7days.The isolation rates of MDROs,mechanical ventilation days,length of stay in ICU,and28day mortality among groups were compared and analyzed.ResultsA total of86patients were enrolled in the investigation,57were males and29were females;the average age was(80.12+10.45)years(range:65-92years).There were40cases in group A,46in group B;24cases in group A1,and16in group A2.The isolation rates of MDROs in group A and group B were65.00%and36.96%respectively,difference was statistically significant(P<0.05);Comparison between two groups of patients revealed that mechanical ventilation days,length of stay in ICU,and28day mortality in group A were all higher than group B,difference was statistically significant(all P<0.05);the isolation rates of MDROs in group A1was higher than group A2(75.00%vs43.75%,P<0.05);mechanical ventilation days of group A1was higher than group A2([7.69±2.22]d vs[6.34±1.56]d,P<0.05);28day mortality and length of stay in ICU between group A1and A2were not significantly different(both P>0.05).ConclusionCarbapenem exposure can increase the occurrence of MDRO infection,especially the non fermentative bacterial colonization or infection,and prolong the mechanical ventilation days and length of stay in ICU,thus affect the prognosis of patients.