ICU耐美罗培南铜绿假单胞菌感染的治疗分析  

Treatment of meropenem-resistant Pseudomonas aeruginosainfection in ICU

作　　者：李娟娟[1] 夏国莲[1] 左阿芳 沈坚英 周跃[1] 

机构地区：[1]浙江省人民医院ICU,浙江杭州310024

出　　处：《中华医院感染学杂志》2016年第9期2038-2040,共3页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科技计划基金资助项目(2015ZB060)

摘　　要：目的探讨ICU耐美罗培南铜绿假单胞菌感染的危险因素,以期采取最佳治疗对策控制感染。方法选择2011年5月-2013年6月医院感染耐美罗培南铜绿假单胞菌35例患者为研究对象,作为研究组,选取同期未感染耐美罗培南铜绿假单胞菌36例患者作为对照组,采用多因素分析感染的相关危险因素,对比治疗前后研究组在白细胞计数、中性粒细胞百分比、体温、C-反应蛋白等炎症指标的变化情况;使用SPSS16.0软件对数据进行统计分析。结果机械通气时间>1周、入住ICU时间>1周、经验性使用碳青霉烯类抗菌药物是ICU住院患者感染耐美罗培南铜绿假单胞菌的相关危险因素(P<0.05);而机械通气时间、入住ICU时间、经验性使用碳青霉烯类抗菌药物是ICU感染耐美罗培南铜绿假单胞菌独立危险因素(P<0.01);研究组患者治疗前白细胞、中性粒细胞、体温、C-反应蛋白分别为(14.73±5.62)×109/L、(81.42±5.68)%、(39.11±0.34)℃、(67.35±36.36)mg/L,治疗后分别为(7.83±1.23)×109/L、(58.95±4.23)%、(36.72±0.25)℃、(6.78±3.56)mg/L,治疗前后比较差异有统计学意义(P<0.05)。结论早期细菌学检查确诊致病菌,减少经验性碳青霉烯类抗菌药物使用,加强ICU消毒隔离措施,减少机械通气时间,可有效降低ICU耐美罗培南铜绿假单胞菌感染。OBJECTIVE To explore the risk factors for meropenem-resistant Pseudomonas aeruginosa infection in ICU so as to take optimal measures for control of the infection.METHODS A total of 35 patients with meropenemresistant P.aeruginosainfection who were treated in the hospital from May 2011 to Jun 2013 were recruited as the study objects and assigned as the study group,meanwhile,36 patients without meropenem-resistant P.aeruginosa infection were set as the control group.The multivariate analysis was conducted for the related risk factors for the infection,the changes of the inflammatory indicators such as white blood cell counts,percentage of neutrophils,body temperature,and C-reactive protein were observed and compared before and after the treatment,and the statistical analysis of data was performed with the use of SPSS16.0software.RESULTS The more than 1week of mechanical ventilation duration,more than 1week of ICU stay,and empirical use of carbapenems were the related risk factors for the meropenem-resistant P.aeruginosainfection in ICU（P〈0.05）;the mechanical ventilation duration,ICU stay,and empirical use of carbapenems were the independent risk factors for the meropenem-resistant P.aeruginosainfection in ICU（P〈0.01）.The white blood cell counts of the study group was（14.73±5.62）×109/L before the treamtent,（7.83±1.23）×109/L after the treamtnet;the percentage of neutrophils was（81.42±5.68）% before the treamtent,（58.95 ± 4.23）% after the treatment;the body temperature was（39.11±0.34）℃ before the teatment,（36.72±0.25）℃ after the treatment;the level of C-reactive protein was（67.35±36.36）mg/L before the treatment,（6.78±3.56）mg/L after the treatment;there was significant difference before and after the treatment（P〈0.05）.CONCLUSIONIt is an effective way to conduct the bacteriological examination in early stage,reduce the empirical use of carbapenems,strengthen the disinfection of ICU and implementation of isolation measures,and shorten the mechanical ventilati

关 键 词：重症监护病房 感染 耐美罗培南铜绿假单胞菌 治疗对策 

分 类 号：R378.991[医药卫生—病原生物学]