医院耐碳青霉烯类铜绿假单胞菌的流行及相关因素分析  

Analysis of prevalence and correlation factors for carbapenem-resistant Pseudomonas aeruginosa in an hospital

作　　者：王娜[1] 贾俐萍[1] 王莉[1] 冯欣[1] 魏鹍[1] 

机构地区：[1]秦皇岛市第一医院,河北秦皇岛066000

出　　处：《中国医院药学杂志》2016年第2期138-141,共4页Chinese Journal of Hospital Pharmacy

基　　金：河北省卫生厅基金项目(编号:20130288)

摘　　要：目的：分析耐碳青霉烯类铜绿假单胞菌（CRPA）发生的流行趋势及相关因素,为CRPA的防治提供临床依据。方法：回顾性分析某院2012年1月-2014年12月946株铜绿假单胞菌对碳青霉烯类的耐药情况,2014年1月-12月281例铜绿假单胞菌阳性患者的临床资料,采用χ2检验、秩和检验、Logistic回归等分析CRPA的发生率及危险因素。结果：CRPA检出率由2012年的41.5%升至2014年的46.9%,与抗菌药物使用强度明显相关（r=0.738,P=0.006）。高龄[相对比值比（OR）=1.028,95%可信区间（95%CI）1.012~1.045,P=0.001]、入住ICU（OR=3.849,95%CI1.776~8.338,P=0.001）、机械通气（OR=3.313,95%CI 1.504~7.295,P=0.003）和经验性使用广谱抗菌药物（OR=2.352,95%CI 1.136~4.872,P=0.021）是CRPA检出的独立危险因素。在广谱抗菌药物中,使用碳青霉烯类（OR=13.326,95%CI 5.783~30.709,P=0.000）和β-内酰胺酶抑制剂复方制剂（OR=3.273,95%CI 1.403~7.633,P=0.006）与CRPA的检出有关。结论：医院CRPA检出率较高,应加强管理,以减少耐药株的播散和流行。OBJECTIVE To investigate prevalence of carbapenem-resistant Pseudomonas aeruginosa(CRPA)and analyze correlation factors for isolation of P.aeruginosa,and provide a reference for control and treatment of P.aeruginosa.METHODS A total of 946 strains of CRPA from January 2012 to December 2014,and clinical data of 281 patients with CRPA from January to December 2014 were collected and retrospectively reviewed.Rank sum test,chi-square test and logistic regression analysis were used for statistical analysis.RESULTS Isolated CRPA was increased from41.5% in 2012 to 46.9% in2014 which was significantly correlated with intensity of antibiotic usage(r=0.738,P=0.006).The risk factors for CRPA isolation were elder people[odds ratio(OR)=1.028,95% confidence interval(95%CI)1.012~1.045,P=0.001],stay in intensive care unit(OR=3.849,95%CI 1.776-8.338,P=0.001),mechanical ventilation(OR=3.313,95% CI 1.504~7.295,P=0.003),and use of broad-spectrum antibiotics(OR=2.352,95%CI 1.136-4.872,P=0.021).Further analysis demonstrated that combined carbapenems(OR=13.326,95%CI 5.783-30.709,P=0.000)andβ-lactam/β-lactamase inhibitors(OR=3.273,95%CI 1.403~7.633,P=0.006)were the correlation factor for CRPA isolation.CONCLUSION Incidence of CRPA isolation is high in this hospital,and management should be enhanced to reduce dissemination and prevalence of drug-resistant bacteria.

关 键 词：铜绿假单胞菌 碳青霉烯 耐药性 危险因素 

分 类 号：R378.991[医药卫生—病原生物学]