多药耐药铜绿假单胞菌院内感染危险因素及预后因素分析

Risk factors and clinical outcomes of nosocomial infections caused by multidrug resistant Pseudomonas aeruginosa

目的 分析多药耐药铜绿假单胞菌 (MDRP)产生的危险因素 ,并探讨影响MDRP院内感染预后的因素。方法 采用病例对照研究方法。收集北京协和医院 1999年 1月～ 2 0 0 2年 12月MDRP引起的院内感染 44例 ,并随机选择同时期敏感铜绿假单胞菌院内感染 68例作为对照 ,采用单因素 (t检验 ,χ2 检验 )及多因素Logistic回归进行分析。结果 对 112例铜绿假单胞菌院内感染单因素分析发现 ,下列因素与MDRP感染有关 :高龄、高APACHEⅡ (acutephysiologyandchronichealthevaluation)评分、2种以上细菌混合感染、院内获得性肺炎 (HAP)、机械通气、患有慢性阻塞性肺疾病(COPD)、分离出MDRP前 15天用过氟喹喏酮、分离出MDRP前 15天用过亚胺培南 /美罗培南。但多因素Logistic回归分析仅确定了 2项独立危险因素 :机械通气 [比值比 (OR) =8 19] ,分离出MDRP前15天用过亚胺培南 /美罗培南 (OR ,44 80 )。 44例MDRP院内感染 ,死亡 2 4例 ,好转 2 0例 ,病死率为55%。单因素分析发现 ,下列因素与MDRP感染死亡相关 :高APACHEⅡ评分、机械通气、未恢复对抗铜绿假单胞菌抗生素的敏感性。多因素Logistic回归分析发现了 1项独立危险因素 :未恢复对抗铜绿假单胞菌抗生素的敏感性 (OR =10 70 )。结论 机械通气 ,以及亚胺培南 /美罗培?

Objective To investigate th e risk factors for multi-drug resistant Pseudomonas aeruginosa(MDRP) infections, and the factors related with poor prognosis of P aeruginosa infections Methods The data of 44 cases of MDRP nosocomial infections were analyzed from Jan,1999 to Dec,2002 in Peking Union Medical Hospital; 68 cases of antibiotic-sensitive P aeuroginosa infection were randomized as control T test , chi-square test and Logistic regression analysis were used for statistics Results According to univariate analysis, the factors associated with the development of MDRP nosocomial infection were age, APACHE Ⅱ, co-infection with other pathogens, hospital acquired pneumonia (HAP), mechanical ventilation, COPD, fluoroquinolone and imipenem/meropenem use 15 days before isolation of MDRP Multivariate logistic regression analysis identified two independent factors: mechanical ventilation and previous imipenem/meropenem use Of 44 cases of MDRP infections, 24 died, and 20 survived Univariate analysis revealed that three factors (APACHE Ⅱ, mechanical ventilation, resistance switch) were associated with clinical prognosis But a ccording to multivariate logistic regression analysis, only resistance switch was a predictive factor Conclusions Mechanical ventilation and previous imipenem/meropenem use were independent risk factors for MDRP infection Resistance switch was a predictive factor for the prognosis of MDRP infection