探讨人工气道患者耐碳青霉烯类铜绿假单胞菌肺部感染的危险因素

Discussion on Risk Factors for Carbapenem-resistant Pseudomonas Aeruginosa in Patients With Artificial Airways

目的探讨人工气道患者耐碳青霉烯类铜绿假单胞菌肺部感染危险因素。方法选择2018年7月-2020年7月人工气道患者218例作为对象,所有患者均使用耐碳青霉烯类抗菌药物,根据患者肺部是否感染铜绿假单胞菌分为感染组与非感染组。查阅两组病例资料,对上述可能的危险因素进行单因素及多因素Logistic分析;对感染的铜绿假单胞菌菌株进行耐药性分析。结果218例人工气道患者耐碳青霉烯类抗菌药物中铜绿假单胞菌菌肺部感染61例,感染率为27.98%。单因素结果表明:人工气道患者耐碳青霉烯类抗菌药物铜绿假单胞菌菌肺部感染率与性别、年龄、合并基础疾病、白细胞水平差异无统计学意义(P>0.05);与入院前卧床时间、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)、白蛋白、机械通气时间、抗菌药物使用差异有统计学意义(P<0.05)。61例铜绿假单胞菌菌肺部感染患者中分离出病原菌78株,对常用的抗菌药物进行耐药性分析,结果表明:铜绿假单胞菌耐药性前三位分别为环丙沙星、左氧氟沙星及庆大霉素,分别占:44.87%、42.31%和34.62%。结论人工气道患者耐碳青霉烯类抗菌药物铜绿假单胞菌菌肺部感染率较高,受到的影响因素较多,具有较高的耐药性,应加强病原菌鉴定及耐药性分析,选择敏感抗菌药物治疗。

Objective To investigate the risk factors of carbapenemresistant Pseudomonas aeruginosa in patients with artificial airway.Methods A total of 218 patients with artificial airway from July 2018 to July 2020 were selected as subjects.All patients were resistant to carbapenem antibacterial drugs.According to whether the patients’lungs were infected with Pseudomonas aeruginosa,they were divided into infection group and non-infectious group.The data of the two groups of cases were consulted,single-factor and multi-factor Logistic analysis of the above-mentioned possible risk factors were carried out;the drug resistance analysis of the infected Pseudomonas aeruginosa strains was carried out.Results Among 218 patients with artificial airways,61 cases of lung infections were caused by Pseudomonas aeruginosa among Carbapenem-resistant antibacterial drugs,and the infection rate was 27.98%.The univariate results showed that the lung infection rate of patients with artificial airway resistant to Carbapenem antibiotics Pseudomonas aeruginosa was not statistically significant with gender,age,combined underlying diseases,and white blood cell level(P>0.05);and the difference before admission bedtime,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,C reactive protein(CRP),procalcitonin(PCT),albumin,mechanical ventilation time,and use of antibacterial drugs were statistically significant(P<0.05).78 pathogenic bacteria were isolated from 61 patients with Pseudomonas aeruginosa pulmonary infection,and the resistance analysis of commonly used antibacterial drugs showed that the top three resistance of Pseudomonas aeruginosa were ciprofloxacin.levofloxacin and gentamicin,accounting for 44.87%,42.31%and 34.62%respectively.Conclusion Pseudomonas aeruginosa has a higher lung infection rate in patients with artificial airway resistant to carbapenem antibiotics,and is affected by many factors,and has higher drug resistance.The identification of pathogens and drug resistance analysis should be strengthened,and select sensitive antibacterial drugs therapy.