无菌体液标本中碳青霉烯类异质性耐药铜绿假单胞菌的危险因素分析  

Risk factors analysis of carbapenem heterogeneous drug resistance Pseudomonas aeruginosa in sterile body fluid samples

作　　者：赖汉瑜 岑丽莲[1] LAI Hanyu;CEN Lilian(Department of Clinical Laboratory,the First People′s Hospital of Zhaoqing,Zhaoqing,Guangdong 526060,China)

机构地区：[1]肇庆市第一人民医院检验科,广东肇庆526060

出　　处：《检验医学与临床》2023年第17期2552-2556,共5页Laboratory Medicine and Clinic

摘　　要：目的研究无菌体液标本中碳青霉烯异质性耐药(HR)铜绿假单胞菌(CHPA)感染的危险因素及其临床特征,为感染控制和指导临床合理用药提供参考依据。方法选取2020年1月至2021年12月肇庆市第一人民医院临床送检无菌体液中非重复培养标本,分离出首次非重复铜绿假单胞菌139株作为研究标本。使用K-B法初筛,群体谱分析(PAP)实验确认CHPA菌株。采用多因素Logistic回归分析患者感染CHPA菌株的危险因素。结果K-B法初筛结果提示分离株中存在碳青霉烯HR。经PAP确认,139株临床分离株中61株为CHPA菌株,HR率为43.88%。其中对亚胺培南(IPM)-HR检出29株,HR率为20.86%;美罗培南(MEM)-HR检出19株,HR率为13.67%。同时对MEM和IPM均表现为HR的CHPA有13株,占9.35%。多因素Logistic回归分析结果显示,侵入治疗手段(OR=5.165,95%CI:1.158~23.033,P=0.031)、多次感染(OR=13.203,95%CI:3.698~47.136,P<0.001)、老年(OR=3.258,95%CI:1.054~10.076,P=0.040)和男性(OR=47.793,95%CI:4.406~518.371,P=0.001)是IPM-HR感染的独立危险因素;而WBC升高(OR=0.848,95%CI:0.740~0.973,P=0.018)是IPM-HR感染的保护因素。多次感染(OR=3.582,95%CI:1.284~9.999,P=0.015)是MEM-HR感染的独立危险因素。侵入治疗手段(OR=16.046,95%CI:4.231~60.853,P<0.001)、多次感染(OR=14.700,95%CI:5.279~40.938,P<0.001)和男性(OR=3.312,95%CI:1.074~10.215,P=0.037)是CHPA感染的独立危险因素;而WBC升高(OR=0.891,95%CI:0.798~0.995,P=0.041)是CHPA感染的保护因素。结论无菌体液标本中分离的铜绿假单胞菌存在对碳青霉烯HR的现象,可通过针对其危险因素补充实验,提高CHPA的检出率,防控CHPA的感染和传播。Objective To investigate the risk factors and clinical characteristics of carbapenem heterogeneous drug resistance(HR)Pseudomonas aeruginosa(CHPA)infection in sterile body fluid samples,and to provide reference basis for infection control and clinical rational drug use.Methods A total of 139 first non-repeated Pseudomonas aeruginosa strains were isolated from sterile body fluid samples in the First People′s Hospital of Zhaoqing from January 2020 to December 2021.The CHPA strain was screened by K-B method and confirmed by population spectrum analysis(PAP).Multivariate Logistic regression was used to analyze the risk factors of CHPA infection.Results The results of K-B method suggested that there was HR to carbapenem in isolotes.PAP confirmed that 61 of 139 clinical isolates were CHPA strains,and the HR rate was 43.88%.Among them,29 strains were detected for imipenem(IPM)-HR,the HR rate was 20.86%,and 19 strains of Meropenem(MEM)-HR were detected,the HR rate was 13.67%.There were 13 CHPA strains that showed HR for both MEM and IPM,accounting for 9.35%.Multivariate Logistic regression analysis showed that invasive treatment(OR=5.165,95%CI:1.158-23.033,P=0.031),multiple infection(OR=13.203,95%CI:3.698-47.136,P<0.001),elderly(OR=3.258,95%CI:1.054-10.076,P=0.040)and male(OR=47.793,95%CI:4.406-518.371,P=0.001)were the independent risk factors for IPM-HR infection.Elevated WBC(OR=0.848,95%CI:0.740-0.973,P=0.018)was a protective factor for IPM-HR infection.Multiple infection(OR=3.582,95%CI:1.284-9.999,P=0.015)was an independent risk factor for MEM-HR infection.Invasive treatment(OR=16.046,95%CI:4.231-60.853,P<0.001),multiple infection(OR=14.700,95%CI:5.279-40.938,P<0.001)and male(OR=3.312,95%CI:1.074-10.215,P=0.037)were the independent risk factors for CHPA infection.Elevated WBC(OR=0.891,95%CI:0.798-0.995,P=0.041)was a protective factor for CHPA infection.Conclusion There is a certain degree of HR to carbapenems in Pseudomonas aeruginosa isolated from sterile body fluid samples.It is necessary to supplement the experim

关 键 词：亚胺培南 美罗培南 异质性耐药 铜绿假单胞菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学]