碳青霉烯类抗生素耐药铜绿假单胞菌感染的临床研究  

Clinical investigation of infections caused by carbapenem-resistant Pseudomonas aeruginosa in Huashan hospital

作　　者：袁莉莉[1] 丁百兴[1] 沈震[1] 吴湜[1] 徐晓刚[1] 李光辉[1] 

机构地区：[1]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,上海200040

出　　处：《中国感染与化疗杂志》2017年第2期121-126,共6页Chinese Journal of Infection and Chemotherapy

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 investigate the clinical characteristics of the infections caused by carbapenem-resistant Pseudomonas aeruginosa （CRPA） for better prevention and treatment of CRPA infections. Methods A retrospective study was conducted to compare the features of CRPA infections （n = 85） and carbapenem-susceptible P aeruginosa （CSPA） infections （n = 94） treated in Huashan Hospital from January 1, 2013 to December 31, 2013. Results The proportion of CRPA infections was significantly higher than CSPA in Neurosurgery （40.0% versus 16.0%） and Intensive Care Unit （22,4%, 9.6%）. Traumatic brain injury （30.6%） and vascular accidents （21.2%） were the main underlying diseases in CRPA patients, which was higher than in CSPA patients （11.7% and 8.5%, respectively）. CRPA infection was associated with significantly higher incidence of fever, altered mental status, and severe hypoproteinemia than CSPA infection. Multiple bacterial infection was found in more CRPA patients （45.9%, 39/85） than in CSPA patients （24.5%, 23/94）. Fewer CRPA patients showed positive treatment response （44.7%, 38/85） than CSPA patients （78.7%, 74/94）. CRPA was associated with significantly more cases of disease progression （55.3%, 47/85） and more deaths （16.5%, 14/85） than CSPA （21.3% and 1.1%, respectively）. Logistic regression analysis indicated that stay in Department of Neurosurgery, prior carbapenem use, peripherally inserted central catheter, nasal feeding, and mechanical ventilation were therisk factors for CRPA infection. Conclusions No specific clinical manifestation is associated with CRPA infection, which poses a therapeutic challenge and results in unfavorable prognosis. Rational use of antibacterial agents and appropriate supporting treatments are essential for control of CRPA in Huashan Hospital.

关 键 词：铜绿假单胞菌 碳青霉烯类耐药 感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]