铜绿假单胞菌血流感染多重耐药患者临床特征分析  

Clinical characteristics of multidrug resistant Pseudomonas aeruginosa bloodstream infection

作　　者：苏冬梅[1] 黄燕[1] 刘一[1] 刘颖[1] 张波[1] 

机构地区：[1]空军总医院呼吸内科,北京100142

出　　处：《解放军医学院学报》2017年第2期136-139,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的分析多重耐药(multi-drug resistant,MDR)铜绿假单胞菌(Pseudomonas aeruginosa,PAE)血流感染的临床特点及细菌耐药性。方法纳入本院2013年1月-2016年6月血培养铜绿假单胞菌阳性病例,比较多重耐药组(MDR,n=27)与非多重耐药组(非MDR,n=40)的临床特征及细菌耐药性。结果共纳入67例。MDR组27例,平均年龄(57.59±23.43)岁,男性19例;非MDR组40例,平均年龄(46.48±26.98)岁,男性24例。与非MDR组相比,MDR组男性比例、APACHEⅡ评分、血培养阳性报警时间(time to positivity of blood cultures,TTP)、入住ICU、合并外科手术、有创机械通气、感染前1个月抗生素应用≥7 d、感染前1个月使用碳青霉烯类药物、出现败血症及休克、死亡率均高于非MDR组(P<0.05)。感染后住院时间、经验性敏感抗生素治疗方面,非MDR组高于MDR组(P<0.05)。MDR铜绿假单胞菌对亚胺培南、美罗培南、哌拉西林表现出较高的耐药性,耐药率分别为74.1%、70.4%、63.0%。ROC曲线表明TTP≥15.89 h是预测患者多重耐药的最佳截断值,曲线下面积为0.795(P<0.001),预测的准确度为中等。结论铜绿假单胞菌血流感染多重耐药率高,多重耐药组患者病情重,病死率高,TTP可作为预测患者多重耐药的早期指标。Objective To analyze the clinical characteristics and drug resistance of multi-drug resistant（MDR） Pseudomonas aeruginosa（PAE） bloodstream infections.Methods Clinical characteristics and drug resistance were analyzed retrospectively based on clinical data about patients with MDR（n=27） or non-MDR（n=40） Pseudomonas aeruginosa bloodstream infections in Air Force Hospital of PLA from January 1, 2013 to June 30, 2016.Results A total of 67 patients were enrolled in this study, including 27 MDR and 40 non-MDR cases with mean age of 57.59±23.43 years in MDR group and 46.48±26.98 years in non-MDR group.There were 19 males in MDR group and 24 males in non-MDR group.Compared with the patients in non-MDR group, patients infected by MDR strains had higher APACHEⅡscore and longer time to positivity of blood cultures（TTP）, higher rate of antibiotics usuage more than 7 days within previous one month, and carbapenem antibiotics usuage within previous one month before infection（P〈0.05, respectively）.Patients with MDR-PAE infection were more likely to be male, admission to ICU, combined with surgery, with invasive mechanical ventilation, sepsis and septic shock（P〈0.05, respectively）.While in non-MDR group, more patients received initial susceptible antibiotic therapy and had greater length of hospital stay after infection when compared with MDR group（P〈0.05）.MDR-PAE resisted to imipenem, meropenem and piperacillin with rates of 74.1%, 70.4% and 63% respectively.ROC curves showed that TTP of 15.89 h was the optimal cutoff point to distinguish MDR and non-MDR, with the area under the curve（AUC） of 0.795（P〈0.001）, and the diagnostic accuracy was medium.Conclusion The MDR rate of Pseudomonas aeruginosa in bloodstream infection is high, and patients show severe adverse clinical outcomes and high mortality.TTP can be used as an early indicator in predicting multidrug resistance of Pseudomonas aeruginosa bloodstream infections.

关 键 词：铜绿假单胞菌 血流感染 多重耐药 临床特征 

分 类 号：R378.991[医药卫生—病原生物学] R446.5[医药卫生—基础医学]