重症监护室呼吸机相关性肺炎患者铜绿假单胞菌多重耐药情况与危险因素分析

Analysis of situation and risk factors of multiple drug resistance of Pseudomonas aeruginosa in patients with ventilator-associated pneumonia in intensive care unit

目的分析重症监护室(ICU)行机械通气患者发生多重耐药铜绿假单胞菌呼吸机相关性肺炎(Pseudomonas aeruginosa ventilator-associated pneumonia,PA-VAP)的耐药特点及危险因素。方法回顾性收集2018年3月至2023年3月随州市中心医院ICU收治的PA-VAP患者临床资料,根据患者是否发生多重耐药分为敏感组和耐药组,分析两组患者耐药特点,并使用Logistic回归和受试者工作特征(receiver operating characteristic,ROC)曲线分析PA-VAP患者发生多重耐药的危险因素。结果共纳入130例PA-VAP患者,其中敏感组和耐药组各65例。PA-VAP患者对亚胺培南(60.0%)、左氧氟沙星(50.8%)、环丙沙星(50.8%)、头孢他啶(50.8%)耐药率较高,对多黏菌素(7.7%)和阿米卡星(16.9%)较少耐药。Logistic回归分析显示,气管切开[OR=6.045,95%CI(2.416,15.125)]、抗菌药物种类≥3种[OR=2.704,95%CI(1.062,6.881)]、使用碳青霉烯类抗生素[OR=4.283,95%CI(1.642,11.173)]是PA-VAP患者发生多重耐药的独立危险因素(P<0.05)。以上三种因素联合应用的ROC曲线下面积为0.824[95%CI(0.752,0.896)],敏感度为0.785,特异度为0.738。结论ICU机械通气PA-VAP患者对抗生素耐药率较高,气管切开、抗菌药物种类≥3种、使用碳青霉烯类抗生素增加多重耐药的发生风险,临床上需针对性采取措施进行预防和治疗。

Objective To analyze the drug resistance situation and risk factors of multi-drug resistant in patients with ventilator-associated pneumonia caused by Pseudomonas aeruginosa(PA-VAP)in intensive care unit(ICU)undergoing mechanical ventilation.Methods The clinical data of PA-VAP patients in ICU in Suizhou Central Hospital from March 2018 to March 2023 were collected retrospectively.PA-VAP patients were divided into sensitive group and drug resistance group according to whether they were infected with multi-drug resistant PA.The drug resistance characteristics between the two groups were analyzed and the risk factors were analyzed using Logistic regression and receiver operating characteristic(ROC)curve.Results A total of 130 patients with PA-VAP were included.There were 65 patients each in the sensitive group and drug-resistant group.PA-VAP patients had high resistance rate to imipenem(60.0%),levofloxacin(50.8%),ciprofloxacin(50.8%),and ceftazidime(50.8%),but low resistance to polymyxin(7.7%)and amikacin(16.9%).Logistic regression analysis showed that tracheostomy[OR=6.045,95%CI(2.416,15.125)],≥3 types of antibiotics[OR=2.704,95%CI(1.062,6.881)],and use of carbapenem antibiotics[OR=4.283,95%CI(1.642,11.173)]were independent risk factors for the multiple drug resistance in PA-VAP patients(P<0.05).The area under the ROC curve for the combined application of the above three factors was 0.824[95%CI(0.752,0.896)],with a sensitivity of 0.785 and a specificity of 0.738.Conclusion ICU mechanically ventilated patients with PA-VAP have a high rate of antibiotic resistance.Tracheostomy,the use of≥3 types of antibiotics,and the use of carbapenems increase the risk of multiple drug resistance.Targeted measures need to be taken for the prevention and treatment of multiple drug resistance PA-VAP patients in clinical practice.