医学新知2024，Vol.34Issue(6)：630-638,9.DOI:10.12173/j.issn.1004-5511.202401033
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
摘要
Abstract
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.关键词
重症监护室/机械通气/多重耐药/铜绿假单胞菌/呼吸机相关性肺炎/危险因素Key words
Intensive care unit/Mechanical ventilation/Multiple drug resistance/Pseudomonas aeruginosa/Ventilator-associated pneumonia/Risk factor引用本文复制引用
何苗勃,赖鹏舒,戴璐婷,张丽娇,黄玉琴,黄强,徐化强,周权..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[J].医学新知,2024,34(6):630-638,9.基金项目
湖北省重点研发计划"大健康"项目(2022BCE058) （2022BCE058）
湖北医药学院研究生科技创新项目(YC2022050) （YC2022050）
