耐碳青霉烯铜绿假单胞菌血流感染患者的细菌耐药性、感染风险因素及预后分析

Bacterial Resistance,Risk Factors and Prognosis of Patients with Carbapenem-Resistant Pseudomonas aeruginosa Bloodstream Infection

目的:探讨耐碳青霉烯类铜绿假单胞菌(CRPA)血流感染患者的细菌耐药性、感染风险因素及对预后的影响因素。方法:回顾性分析2018年1月~2021年12月本院收治的215例铜绿假单胞菌血流感染患者的临床资料及菌株对常用抗菌药物的耐药情况,比较CRPA组和非耐碳青霉烯类铜绿假单胞菌(NCRPA)组、CRPA组中死亡组与存活组的临床特征,并探讨CRPA血流感染的风险因素及对预后的影响因素。结果:215株铜绿假单胞菌主要来源于血液科(71例,33.0%)和重症加强护理病房(ICU,69例,32.1%),其中CRPA共59株(27.4%)。CRPA组对β内酰胺类药物(哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、氨曲南)、喹诺酮类药物(环丙沙星、左氧氟沙星)和氨基糖苷类药物(阿米卡星、庆大霉素)的耐药率均高于NCRPA组(P<0.05)。单因素分析结果显示,男性患者占比、低蛋白血症、转院转科史、留置胃管、中心静脉置管、机械通气、入住ICU、感染前住院时长、应用碳青霉烯类抗菌药物及联用2种抗菌药物与CRPA血流感染有关(P<0.05);Logistic回归分析进一步显示应用碳青霉烯类抗菌药物、联用2种抗菌药物及感染前住院时长是CRPA血流感染的独立风险因素(P<0.05)。此外,CRPA血流感染患者死亡率为42.4%,Logistic回归分析提示脓毒症休克(P=0.001)及机械通气(P=0.021)是CRPA血流感染患者死亡的独立风险因素。结论:铜绿假单胞菌血流感染中,CRPA死亡率较高,且菌株对常用药物呈现出一定程度的耐药性。应用碳青霉烯类药物、联用2种抗菌药物及感染前住院时长是CRPA血流感染的主要风险因素,机械通气及脓毒症休克与CRPA血流患者预后较差相关。耐药性及风险因素分析对临床识别CRPA感染、优化抗菌药物的使用及治疗预后不良的高危患者具有一定实际意义。

Objective:To investigate the bacterial resistance,infection risk factors and prognostic factors in patients with carbapenem-resistant Pseudomonas aeruginosa(CRPA)bloodstream infection.Methods:The clinical data of 215 patients with Pseudomonas aeruginosa bloodstream infection in our hospital from January 2018 to December 2021 and resistance of strains to commonly used antibiotics were retrospectively analyzed.The clinical characteristics of CRPA group and non-carbapenem-resistant Pseudomonas aeruginosa(NCRPA)group,death group and survival group in CRPA group were compared,and the risk factors and prognostic factors of bloodstream infection of CRPA were also explored.Results:215 strainsof Pseudomonas aeruginosa were mainly derived from Hematology department(71 cases,33.0%)and Intensive care unit(ICU,69 cases,32.1%),and there were 59 strains of CRPA(27.4%).Drug resistance rate of beta-lactam drugs(piperacillin,piperacillin-tazobactam,ceftazidime,cefepime,aztreonam),quinolones(ciprofloxacin,levofloxacin)and aminoglycoside drugs(amikacin,gentamicin)in CRPA group were significantly higher than those in NCRPA group(P<0.05).Univariate analysis showed that the proportion of male patients,hypoproteinemia,history of hospital transfer,gastric intubation,central vein catheterization,mechanical ventilation,admission to ICU,length of hospital stay before infection,use of carbapenems and combined use of two antibiotics were associated with CRPA bloodstream infection(P<0.05).Logistic regression analysis showed that carbapenem antibiotic use,combined use of two antibiotics and length of hospital stay before infection were independent risk factors for bloodstream infection of CRPA(P<0.05).In addition,the mortality rate of patients with bloodstream infection of CRPA was 42.4%.Logistic regression analysis revealed septic shock(P=0.001)and mechanical ventilation(P=0.021)were independent risk factors for death in patients with CRPA bloodstream infection.Conclusion:In the bloodstream infection of Pseudomonas aeruginosa,the mortality rate of CRPA was high,and the strains showed a certain degree of resistance to common drugs.Carbapenems,combined use of two antimicrobial agents and length of hospital stay before infection are the main risk factors for CRPA bloodstream infection.Mechanical ventilation and septic shock are associated with poor prognosis in CRPA bloodstream patients.The analysis of drug resistance and risk factors has certain practical significance for identifying CRPA infection,optimizing the use of antibiotics and treating high-risk patients with poor prognosis.