人工气道患者耐碳青霉烯类抗菌药物铜绿假单胞菌肺部感染危险因素

Risk factors for carbapenem-resistant Pseudomonas aeruginosa pulmonary infection in patients with artificial airway

目的分析重症医学科建立人工气道机械通气患者碳青霉烯类抗菌药物耐药铜绿假单胞菌(Carbapenem-resistant Pseudomonas aeruginosa,CRPA)肺部感染的危险因素及耐药性。方法选择2016年1月-2019年12月首都医科大学附属北京世纪坛医院重症医学科铜绿假单胞菌(Pseudomonas aeruginosa,PA)感染患者388例,其中CRPA肺部感染患者251例为研究组,碳青霉烯类抗菌药物敏感铜绿假单胞菌(Carbapenem-sensitive Pseudomonas aeruginosa,CSPA)肺部感染患者137例为对照组,比较两组患者年龄、合并基础疾病、抗菌药物使用及炎症因子指标等临床资料,分析人工气道机械通气患者CRPA肺部感染的危险因素,分析两组患者对常用抗菌药物的耐药性,并对PA常见耐药基因进行检测。结果两组患者年龄、APACHEⅡ评分、入院前卧床时间、炎症因子水平、合并慢性阻塞性肺病(COPD)、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物、低蛋白血症比较差异有统计学意义(P<0.05);其中合并COPD、机械通气时间>10 d、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物是人工气道患者CRPA感染的独立危险因素(P<0.05);研究组对常用抗菌药物的耐药率均高于对照组;研究组除对阿米卡星耐药率为16.33%,头孢他啶25.50%外,其余耐药率均高于55.00%。碳青霉烯类抗菌药物耐药铜绿假单胞菌含有IMP、VIM、OXA-23、OXA-51等多种耐药基因。结论CRPA肺部感染与合并COPD、铜绿假单胞菌检出前使用过碳青霉烯类抗菌药物、机械通气等多种因素相关,CRPA含有多种碳青霉烯类抗菌药物耐药基因,耐药率较高,预后差。

OBJECTIVE To investigate the risk factors for carbapenem-resistant Pseudomonas aeruginosa(CRPA)pulmonary infection in patients with artificial airway in intensive care unit(ICU)and analyze the drug resistance.METHODS A total of 388 patients with P.aeruginosa infection who were treated in ICU of Beijing Shijitan Hospital,Capital Medical University from Jan 2016 to Dec 2019 were enrolled in the study,251 of whom had CRPA pulmonary infection and were assigned as the study group,and 137 had carbapenem-sensitive Pseudomonas aeruginosa(CSPA)pulmonary infection and were set as the control group.The clinical data such as age,complication with underlying diseases,use of antibiotics and inflammatory factors were compared between the two groups of patients,the risk factors for the CRPA pulmonary infection in the patients with artificial airway were analyzed,the drug resistance to the commonly used antibiotics was observed,and the common drug resistance genes of the P.aeruginosa strains were detected.RESULTS There were significant difference in the age,APACHE II score,bedridden time before admission,inflammatory factors,complication with chronic obstructive pulmonary disease(COPD),use of carbapenems before isolation of P.aeruginosa and hypoproteinemia between the two groups of patients(P<0.05).The complication with COPD,duration of mechanical ventilation more tan 10 days and use of carbapenems before isolation of P.aeruginosa were the independent risk factors for the CRPA infection in the patients with artificial airway(P<0.05).The drug resistance rates to the commonly used antibiotics were higher in the study group than in the control group.The drug resistance rate to amikacin was 16.33%in the study group,ceftazidime 25.5%;the drug resistance rates to other antibiotics were higher than 55.0%.The carbapenem-resistant P.aeruginosa strains contained many resistant genes such as IMP,VIM,OXA-23 and OXA-51.CONCLUSION The CRPA pulmonary infection is associated with multiple factors including the complication with COPD,use of carbapenems before isolation of P.aeruginosa and mechanical ventilation.The CRPA strains contain the drug resistance genes to carbapenems,the drug resistance rate is high,and the prognosis is poor.