耐亚胺培南铜绿假单胞菌致医院感染危险因素的病例对照研究  

A case-control study on the risk factors of nosocomial infection caused by imipenem-resistant Pseudomonas aeruginosa

作　　者：彭少华[1] 金正江[1] 罗兰[2] 李从荣[1] 

机构地区：[1]武汉大学人民医院检验科,430060 [2]武汉大学公共卫生学院

出　　处：《中华流行病学杂志》2005年第7期511-514,共4页Chinese Journal of Epidemiology

基　　金：湖北省卫生厅重点项目资助(WJ01564)

摘　　要：目的探讨耐亚胺培南铜绿假单胞菌(IRPA)导致医院感染的危险因素.方法选取2002年1月至2003年12月收治的67例IRPA医院感染病例、150例亚胺培南敏感铜绿假单胞菌(ISPA)医院感染者为病例组,同时选取同一病区,接受相似治疗措施的非铜绿假单胞菌感染的住院患者为对照组,其中敏感对照组159例,耐药对照组200例.分别对两组患者的危险因素进行病例对照研究,采用非条件logistic回归分析法进行分析.结果多因素非条件logistic回归分析表明,IRPA医院感染的发生与住院时间长短(OR=1.03,95% CI:1.01～1.04)、亚胺培南(OR=4.65,95%CI:1.35～11.52)、哌拉西林/他唑巴坦(OR=3.37,95% CI:1.85～9.43)及喹诺酮类抗菌药物(OR=1.85,95% CI:1.25～5.34)的使用有关;而ISPA医院感染与三代头孢(OR=2.54,95% CI:1.26～5.23)及氨基糖苷类抗生素(OR=1.86,95% CI:1.42～3.26)的使用、住院时间长短(OR=1.05,95% CI:1.03～1.05)有关.结论为减少IRPA医院感染的发生,在限制使用亚胺培南的同时,应尽可能根据药物敏感试验的结果,合理使用其他抗菌药物.Objective To explore the risk factors for nosocomial infection caused by imipenem-resistant Pseudomonas aeruginosa (IRPA). Methods A case-control study was carried out for the comparison of 2 groups of ‘case’ patients with ‘controlled’ patients. The first group of ‘case’ patients had nosocomial isolation of IRPA, and the second group had imipenem-susceptible Pseudomonas aeruginosa (ISPA). ‘Control’ patients were selected from the same medical or surgical services from which ‘case’ patients were receiving care when isolation of IRPA or ISPA occurred. Risk factors analyzed included the use of antimicrobials, comorbid conditions, and demographic variables. IRPA was recovered from 67 patients, and ISPA from 150 patients while the control case were 200 and 159 respectively. All patients were from Renmin Hospital of Wuhan University during Jan 2002 to Dec 2003. Data were analyzed with unconditional logistic regression and principal component analysis. Results Data from multivariate unconditional logistic regression analysis showed that the independent risk factors for IRPA nosocomial infection were: time at risk( OR = 1.03 ,95% CI : 1.01- 1.04 ),imipenem( OR = 4.65 ,95% CI : 1.35- 11.52 ),PIP/TAZ( OR = 3.37 , 95% CI : 1.85- 9.43 ) and quinolones( OR = 1.85 ,95% CI : 1.25- 5.34 ) while the third cephalosporins( OR =2.54,95% CI : 1.26- 5.23 ) and aminoglycoside antibiotics( OR = 1.86 ,95% CI : 1.42- 3.26 ),time at risk( OR = 1.05 ,95% CI : 1.03- 1.05 ) were associated with isolated ISPA. Conclusion Nosocomial infection of IRPA could be caused by the use of imipenem and other antibiotics, suggesting that to limit the use of imipenem was not sufficient to contain the increasing incidence of IRPA.

关 键 词：耐亚胺培南铜绿假单胞菌 病例对照研究 感染危险因素 非条件LOGISTIC回归分析 logistic回归分析法 哌拉西林/他唑巴坦 铜绿假单胞菌感染 喹诺酮类抗菌药物 氨基糖苷类抗生素 2002年1月 医院感染病例 IRPA 药物敏感试验 

分 类 号：R516[医药卫生—内科学]