碳青霉烯类抗生素耐药铜绿假单胞菌感染的临床研究

发布时间：2018-02-16 17:21

本文关键词： 铜绿假单胞菌碳青霉烯类耐药感染危险因素　出处：《中国感染与化疗杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的分析碳青霉烯类抗生素耐药铜绿假单胞菌感染的临床特征,为碳青霉烯类抗生素耐药铜绿假单胞菌感染的防治提供参考和依据。方法对2013年1-12月复旦大学附属华山医院85例碳青霉烯类耐药铜绿假单胞菌(CRPA)和94例碳青霉烯类敏感铜绿假单胞菌(CSPA)感染病例进行回顾性队列分析。结果 CRPA感染组在神经外科(40.0%)和ICU(22.4%)的占比显著高于CSPA感染组(16.0%和9.6%);CRPA感染组原发疾病主要为脑外伤(30.6%)和脑血管意外(21.2%),显著高于CSPA感染组的11.7%和8.5%;CRPA感染组患者的发热、意识状态改变及严重低蛋白血症占比明显高于CSPA感染组;CRPA感染组39例(45.9%)存在复数菌感染,高于CSPA感染组的23例(24.5%);CRPA感染组抗菌药物治疗有效者38例(44.7%),低于CSPA感染组的74例(78.7%);CRPA感染组病情恶化47例(55.3%),包括死亡14例(16.5%)显著高于CSPA感染组的20例(21.3%)和1例(1.1%)。经过Logistic回归分析得出临床感染CRPA的独立危险因素为先前应用碳青霉烯类、经外周静脉穿刺中心静脉置管、留置鼻饲管和机械通气。结论 CRPA感染临床表现无特征性,但治疗困难,预后更差,其控制关键在于合理使用抗菌药物,并针对危险因素做好医院感染防控。
[Abstract]:Objective to analyze the clinical characteristics of carbapenem antibiotic resistant Pseudomonas aeruginosa infection. Methods 85 cases of carbapenem resistant Pseudomonas aeruginosa infection and 94 cases of carbapenem resistant Pseudomonas aeruginosa infection were studied in Huashan Hospital, Fudan University from 2013 to December, 2013. A retrospective cohort analysis was carried out in patients with CRPA infection. Results the percentage of CRPA infection in neurosurgery and ICU 22. 4) was significantly higher than that in CSPA infection group (16. 0% and 9. 6% respectively) and the main primary diseases were brain trauma (36. 6%) and cerebral blood. The fever of patients with CSPA infection was significantly higher than that of 11.7% and 8.5 patients with CSPA infection. The proportion of consciousness changes and severe hypoproteinemia was significantly higher than that of 39 patients with CSPA infection. Of the 23 patients with CSPA infection higher than that of the CSPA infection group, 38 patients were effective in the treatment of antimicrobial agents, which were significantly lower than those in the CSPA infection group (74 patients with CSPA infection and 74 patients with CSPA infection). The severity of the disease in the CRPAinfected group was significantly higher than that in the CSPA infection group (47 cases, including 14 cases, 16. 5%) and 1 case in the CSPA infection group (21. 3B) and 1 case. Logistic regression analysis showed that the independent risk factors for clinical CRPA infection were carbapenems. Conclusion the clinical manifestation of CRPA infection is not characteristic, but the treatment is difficult and the prognosis is worse. The key to the control lies in the rational use of antimicrobial agents. The prevention and control of nosocomial infection should be done according to the risk factors.
【作者单位】：复旦大学附属华山医院抗生素研究所卫生部抗生素临床药理重点实验室;
【分类号】：R446.5

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