铜绿假单胞菌血流感染71例临床分析  

Clinical analysis of 71 patients with Pseudomonas aeruginosa bloodstream infection

作　　者：林洁 李铭铭 黄鹏 柴丹丹 张青 张胜娜 Jie Lin;Mingming Li;Peng Huang;Dandan Chai;Qing Zhang;Shengna Zhang(Department of Pharmacy,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,Zhejiang Province,China;Department of Laboratory Medicine,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,Zhejiang Province,China;Traditional Chinese Medicine Pharmacy,Ruian Hospital of Traditional Chinese Medicine,Ruian 325299,Zhejiang Province,China)

机构地区：[1]温州医科大学附属第三医院药学部,温州325200 [2]温州医科大学附属第三医院检验科,温州325200 [3]瑞安市中医院中药房,瑞安325299

出　　处：《中国基层医药》2023年第1期81-86,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市医药卫生科学研究项目(2018B19)。

摘　　要：目的:探讨铜绿假单胞菌(PAE)血流感染患者的临床表现特征及相关危险因素,结合细菌耐药情况为临床诊治提供参考。方法:回顾性分析温州医科大学附属第三医院2019年1月至2020年12月所有因PAE血流感染住院患者的临床资料和生物学资料,并用二元logistics回归分析PAE血流感染的独立影响因素。结果:共83例PAE血流感染病例,实际入选71例。在71例铜绿假单胞菌血流感染患者中,耐碳青霉烯类铜绿假单胞菌(CRPA)血流感染患者36例占50.70%。单因素分析显示,90 d内住院史为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=3.90,P=0.048);留置导尿为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=5.08,P=0.024);感染性休克为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=4.00,P=0.046);机械通气为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=12.35,P<0.001);深静脉导管为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=4.08,P=0.043);急性生理与慢性健康评分(APACHEⅡ评分)≥10分为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=4.06,P=0.044);多重耐药为CRPA血流感染的可疑影响因素,差异有统计学意义(χ^(2)=11.75,P=0.001)。经多因素logistics回归分析显示,机械通气是CRPA血流感染的独立危险因素(OR=7.43,95%CI为1.182~46.674,P=0.032);多重耐药是CRPA血流感染的独立危险因素(OR=5.842,95%CI为1.520~22.450,P=0.010)。结论:机械通气、多重耐药为CRPA血流感染的独立影响因素,临床上应尽可能减少机械通气等侵入性操作。Objective To investigate the clinical manifestations and related risk factors of patients with Pseudomonas aeruginosa(PAE)bloodstream infection,and to provide references for clinical diagnosis and treatment of PAE bloodstream infection after combining with bacterial resistance condition.Methods The clinical data and biological data of all patients with PAE bloodstream infection who received treatment in the Third Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 were analyzed retrospectively.The independent influential factors of PAE bloodstream infection were analyzed using binary logistic regression.Results Eighty-three patients had PAE bloodstream infection.Among them,71 patients were included in the final analysis.Among the 71 patients,36 patients(50.70%)had carbapenem-resistant Pseudomonas aeruginosa(CRPA).Univariate analysis showed that the history of hospitalization within 90 days(χ^(2)=3.90,P=0.048),indwelling catheterization(χ^(2)=5.08,P=0.024),septic shock(χ^(2)=4.00,P=0.046),mechanical ventilation(χ^(2)=12.35,P<0.001),deep venous catheter(χ^(2)=4.08,P=0.043),acute physiology and chronic health evaluation score II≥10 points(χ^(2)=4.06,P=0.044),and multi-drug resistance(χ^(2)=11.75,P=0.001)were the suspicious influential factors of CRPA bloodstream infection.Multivariate logistic regression analysis showed that mechanical ventilation was an independent risk factor for CRPA bloodstream infection(OR=7.43,95%CI 1.182-46.674,P=0.032).Multi-drug resistance was an independent risk factor for CRPA bloodstream infection(OR=5.842,95%CI 1.520-22.450,P=0.010).Conclusion Mechanical ventilation and multi-drug resistance are the independent influential factors of CRPA bloodstream infection.Invasive operations such as mechanical ventilation should be avoided in the clinic.

关 键 词：假单胞菌 铜绿 碳青霉烯类 感染 抗菌药 抗药性 微生物 微生物敏感性试验 危险因素 回归分析 

分 类 号：R515[医药卫生—内科学]