临床与病理杂志2017，Vol.37Issue(10)：2078-2084,7.DOI:10.3978/j.issn.2095-6959.2017.10.010
重症医学科多重耐药铜绿假单胞菌致肺部感染的流行病学特征及危险因素
Prevalence and risk factors of multidrug-resistant Pseudomonas aeruginosa pneumonia in intensive care unit
摘要
Abstract
Objective:To investigate the prevalence and risk factors associated with multidrug-resistant Pseudomonas aeruginosa (MDR-Pa) pneumonia among intensive care unit (ICU) patients.Methods:A total of 362 patients with pseudomonas aeruginosa pneumonia from 3 teaching hospitals ICU were enrolled in this retrospective case-control study.Patients with MDR-Pa pneumonia were assigned to MDR-Pa group (n=127),the others were assigned to non-MDR-Pa group (n=235).The prevalence of anti-pseudomonal antibiotic susceptibility was documented.Risk factors included comorbid conditions and prior healthcare exposure (hospitalizations,pseudomonas aeruginosa colonization/infection,mechanical ventilation,etc.) were detected and compared.Results:The anti-pseudomonal antibiotic susceptibility in ICU isolated strains was much lower than that of the CHINET.Multivariate logistic regression analysis showed that antibiotics treatment ≥24 h in preceding 90 days (OR =4.1,95％CI 1.9-6.8),hospitalization ≥48 h in preceding 90 days (OR =2.8,95％CI 1.1-5.4),residence of nursing home (OR =3.5,95％CI 2.0-6.3),pseudomonas aeruginosa colonization or infection in preceding 1 year (OR =5.2,95％CI 1.9-8.4) were the high risk factors for MDR-Pa pulmonary in ICU patients (P＜0.05).Among the prior anti-pseudomonal antibiotic exposure,carbapenems (OR =8.3,95％CI 3.7-22.8),fluoroquinolones (OR =6.3,95％CI 3.2-8.2) and β-lactamase inhibitor (OR =3.2,95％CI 1.5-6.5) were also risk factors (P＜0.05).Conclusion:Patients with MDR-Pa pneumonia should be thoroughly assessed for prior healthcare exposure and anti-pseudomonal antibiotic exposure.关键词
多重耐药/铜绿假单胞菌/危险因素/重症医学科Key words
multidrug-resistance/Pseudomonas aeruginosa/risk factor/intensive care unit引用本文复制引用
林海,余跃天,朱琤,刘春艳,祝燕萍,李敏..重症医学科多重耐药铜绿假单胞菌致肺部感染的流行病学特征及危险因素[J].临床与病理杂志,2017,37(10):2078-2084,7.基金项目
上海市卫计委优秀青年医师培养计划(YQ20150231). This work was supported by Shanghai Municipal Commission of Health and Family Planning,China (YQ20150231). （YQ20150231）
