碳青霉烯类耐药铜绿假单胞菌院内感染及预后的因素分析  

Analysis of factors affecting hospital acquired infections and prognosis of carbapenem resistant Pseudomonas aeruginosa

作　　者：韩萍 张伟[2] 雷春梅 王布[3] 赵建清[3] HAN Ping;ZHANG Wei;LEI Chunmei;WANG Bu;ZHAO Jianqing(Graduate School,Hebei North University,Zhangjiakou 075000,China;Central Laboratory,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院研究生学院,河北张家口075000 [2]河北北方学院附属第一医院中心实验室,河北张家口075000 [3]河北北方学院附属第一医院呼吸与危重症医学科,河北张家口075000

出　　处：《药学研究》2025年第3期282-288,301,共8页Journal of Pharmaceutical Research

基　　金：河北省自然科学基金资助项目(No.C2022405023)。

摘　　要：目的分析碳青霉烯类耐药铜绿假单胞菌(CRPA)感染的分布特点、院内感染及预后影响因素。方法采用回顾性研究方法,分别收集河北北方学院附属第一医院2021至2023年首次诊断为CRPA和碳青霉烯类敏感铜绿假单胞菌(CSPA)感染患者的临床资料,CRPA为病例组(156例),CSPA为对照组(156例),并根据CRPA感染患者住院期间是否死亡分为死亡组(37例)和存活组(119例),使用SPSS 27.0统计学软件对CRPA院内感染及预后因素进行分析,并比较CRPA和CSPA的住院死亡率和30 d死亡率有无差异。结果CRPA和CSPA组最常见的感染类型是呼吸道感染,CRPA主要集中在重症监护室(ICU),为59.0%,而CSPA主要集中在普通内科,为32.1%。多因素Logistic回归分析结果显示:两个及以上科室治疗史(OR=0.274,95%CI:0.099~0.757,P<0.05)、使用β-内酰胺酶抑制剂(OR=3.065,95%CI:1.734~5.420,P<0.01)及碳青霉烯类抗生素(OR=2.329,95%CI:1.217~4.456,P<0.05)是CRPA院内感染的独立影响因素;血肌酐较高[94.20(63.50,282.40);OR=1.005,95%CI:1.001~1.008,P<0.01]为CRPA院内感染预后不良的独立影响因素。CRPA组的住院死亡率和30 d死亡率均高于CSPA(P<0.01),Kaplan-Meier曲线显示,CRPA组的30 d生存时间短于CSPA组(P<0.01)。结论CRPA感染形势较严峻,最常见的感染类型是呼吸道感染,且主要集中在ICU。两个及以上科室治疗史、使用β-内酰胺酶抑制剂及碳青霉烯类抗生素的患者更易感染CRPA,血肌酐较高是其预后不良的独立影响因素。CRPA组的住院死亡率和30 d死亡率均高于CSPA组,且CRPA组的30 d生存时间短于CSPA组。Objective To analyze the distribution characteristics,nosocomial infection and prognostic factors of carbapenem resistant Pseudomonas aeruginosa(CRPA)infection.Methods A retrospective study was conducted to collect clinical data of patients first diagnosed with CRPA and carbapenem-sensitive Pseudomonas aeruginosa(CSPA)infection from 2021 to 2023 in the First Affiliated Hospital of Hebei North University,with CRPA as the case group(156 cases)and CSPA as the control group(156 cases).Patients with CRPA infection were divided into death group(37 cases)and survival group(119 cases)according to whether they died during hospitalization.SPSS 27.0 statistical software was used to analyze the nosocomial infection and prognostic factors of CRPA,and to compare whether there were differences in in-hospital mortality and 30-day mortality between CRPA and CSPA.Results The most common type of infection in the CRPA and CSPA groups was respiratory infection,with CRPA concentrated in the intensive care unit(ICU)at 59.0% and CSPA concentrated in general internal medicine at 32.1%.The results of multivariate Logistic regression analysis showed:history of treatment in two or more departments(OR=0.274,95%CI:0.099~0.757,P<0.05),use of β-lactamase inhibitors(OR=3.065,95%CI:1.734~5.420,P<0.01)and carbapenem antibiotics(OR=2.329,95%CI:1.217~4.456,P<0.05)were the independent influencing factors of CRPA nosocomial infection.High serum creatinine[94.20(63.50,282.40);OR=1.005,95%CI:1.001~1.008,P<0.01]was an independent factor for poor prognosis of CRPA nosocomial infection.In-hospital mortality and 30-day mortality were higher in the CRPA group than in the CSPA group(P<0.01).Kaplan-Meier curve showed that the 30-day survival time in the CRPA group was shorter than that in the CSPA group(P<0.01).Conclusion CRPA infection situation is serious,the most common type of infection is respiratory tract infection,and concentrated in ICU.Patients with a history of treatment in two or more departments,beta-lactamase inhibitors and carbapenems were more

关 键 词：碳青霉烯 铜绿假单胞菌 院内感染 预后 因素 

分 类 号：R446.5[医药卫生—诊断学]