美罗培南用药后脓毒症患者继发多重耐药菌感染影响因素分析

Influencing factors of multidrug-resistant organism infection secondary to meropenem treatment in patients with sepsis

目的探讨美罗培南用药后脓毒症患者继发多重耐药菌(MDRO)感染的影响因素。方法选取2016年1月至2019年1月本院收治的使用美罗培南抗菌治疗的脓毒症患者240例,观察继发性MDRO感染率及病原菌情况,比较继发性MDRO感染组与未感染组人口学资料、急性生理与慢性健康状况评分Ⅱ(A-PACHEⅡ)、合并疾病、侵入式操作、用药时间及实验室指标等临床资料,分析继发MDRO感染影响因素。结果76例发生继发性MDRO感染,感染率为31.67%,共培育分离病原菌85株,其中革兰阴性菌52株,革兰阳性菌33株,病原菌主要是大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、粪肠球菌、阴沟肠杆菌。单因素分析显示,入住重症监护室(ICU)时间>10 d、合并糖尿病、呼吸系统疾病、机械通气、美罗培南用药时间、使用糖皮质激素与继发性MDRO感染有一定关联(P<0.05);多因素分析显示,美罗培南用药时间[OR=1.325,95%CI(1.245,1.618),P=0.001]、机械通气[OR=6.982,95%CI(1.541,30.684),P=0.014]是继发性MDRO感染的独立危险因素。结论美罗培南用药时间、机械通气是使用美罗培南抗菌治疗脓毒症患者继发MDRO感染的影响因素,应引起高度重视。临床上应尽量减少不必要机械通气时间,缩短美罗培南用药时间,严格执行医院各项消毒灭菌措施,避免抗生素的滥用,以降低MDRO感染发病率。

Objective To investigate the influencing factors of multidrug-resistant organism(MDRO)infection secondary to medication with meropenem in septic patients.Methods A total of 240 septic patients given antibacterial therapy with meropenem in our hospital between January 2016 and January 2019 were enrolled,and investigated for incidence of secondary MDRO infection and distribution of pathogens.Demographics,acute physiology and chronic health evaluation scoreⅡ(APACHEⅡ),comorbidities,invasive operation,medication duration and laboratory indicators were compared between patients with and without secondary MDRO,and thereby the influencing factors of secondary MDRO infection was analyzed.Results There were 76 cases of secondary MDRO infection,with the infection rate being 31.67%.Eight-five strains of pathogens were isolated,including 52 of Gram-negative and 33 of Gram-positive bacteria.The pathogens were predominantly Escherichia cok,Psehdomonas aemginosa,Acinetobacter banmannii,Staploloccns anrens,Enterococcns Faecalis and Enterobacter cloacae.Univariate analysis showed that ICU stay>10 d,cormibidity with diabetes or respiratory disease,mechanical ventilation,duration of meropenem use,and use of glucocorticoids were associated with secondary MDRO infection(P<0.05);multivariate analysis showed that duration of meropenem use[OR=1.325,95%CI(1.245,1.618),P=0.001]and mechanical ventilation[OR=6.982,95%CI(1.541,30.684),P=0.014]were independent risk factors for secondary MDRO infection.Conclusion The duration of meropenem use and mechanical ventilation are influential factors of MDRO infection secondary to antibacterial therapy with meropenem in patients with sepsis,and should prompt for high alerts.To reduce the incidence of MDRO infection,it is clinically important to shorten the dispensable duration of mechanical ventilation and meropenem use,rigorously implement disinfection and sterilization measures in hospitals,and avoid irrational use of antibiotics.