[1]吴志农a,熊敏a,谢丹b,等.耐碳青霉烯铜绿假单胞菌医院感染的临床特征及危险因素分析[J].现代检验医学杂志,2020,35(05):137-141.[doi:10.3969/j.issn.1671-7414.2020.05.036]
　WU Zhi-nonga,XIONG Mina,XIE Danb,et al.Clinical Characteristics and Risk Factors in Patients with Carbapenem- Resistant Pseudomonas Aeruginosa Infection in Hospital[J].Journal of Modern Laboratory Medicine,2020,35(05):137-141.[doi:10.3969/j.issn.1671-7414.2020.05.036]
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耐碳青霉烯铜绿假单胞菌医院感染的临床特征及危险因素分析()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第35卷
期数:
2020年05期
页码:
137-141
栏目:
检验与临床
出版日期:
2020-11-01

文章信息/Info

Title:
Clinical Characteristics and Risk Factors in Patients with Carbapenem- Resistant Pseudomonas Aeruginosa Infection in Hospital
文章编号:
1671-7414（2020）05-137-05
作者:
吴志农a; 熊敏a; 谢丹b; 周汉义a
咸宁市中心医院/ 湖北科技学院附属第一医院a. 检验科，b. 急诊科，湖北咸宁 437000
Author(s):
WU Zhi-nonga;  XIONG Mina;  XIE Danb;  ZHOU Han-yia
a. Department of Clinical Laboratory; Department of Emergency, Xianning Center Hospital/the First Affiliated Hospital of Hubei University of Science and Technology, b. Hubei Xianning 437100, China
关键词:
耐碳青霉烯铜绿假单胞菌; 病例对照研究; 临床特征; 危险因素
分类号:
R378.991；R446.5
DOI:
10.3969/j.issn.1671-7414.2020.05.036
文献标志码:
A
摘要:
目的　研究耐碳青霉烯铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa, CRPA) 医院感染的临床特 征及危险因素。方法　收集咸宁市中心医院2017 年6 月~2018 年12 月分离的64 例CRPA 患者的临床资料，随机选择 128 例同期碳青霉烯敏感铜绿假单胞菌（carbapenem-susceptible Pseudomonas aeruginosa ,CSPA）患者作为对照组，采 用病例对照研究的方式分析CRPA 感染临床特征及相关危险因素。结果　两组患者均以痰标本为主，差异无统计学意 义（χ2=6.668，P>0.05）。CRPA 感染主要来自神经外科、呼吸内科及ICU，ICU 患者CRPA 的比例显著高于CSPA 组, 差异有统计学意义（χ2=6.686，P<0.05），CRPA 组对所有12 种抗生素的耐药率均高于CSPA 组，差异有统计学意义 （χ2=10.500~55.185，均P<0.05），CRPA组患者死亡率（25.0%）显著高于CSPA组（10.9%），差异有统计学意义（χ2=6.400， P<0.05）。多因素Logistics 回归分析发现机械通气、使用3,4 代头孢菌素、使用碳青霉烯类抗生素、联合用药、感染前 14 天内入住ICU（均P<0.05，OR>1）是发生CRPA 院内感染的独立危险因素。结论　该院CRPA 感染耐药率高，预后 差，且ICU 比例相对较高；CRPA 感染具有多个独立危险因素，加强对危险因素控制可以有效预防CRPA 感染播散。
Abstract:
Objective　To study the clinical characteristics and risk factors of nosocomial infection of carbapenem resistant Pseudomonas aeruginosa(CRPA). Methods　The clinical data of 64 patients with CRPA isolated from Xianning Central Hospital from June 2017 to December 2018 were collected，128 patients with carbapenem-susceptible pseudomonas aeruginosa (CSPA) were randomly selected as control group, and the clinical feature and risk factors of CRPA infections were analyzed by case-control study. Results　The patients in the two groups were mainly sputum specimens, and there was no significant difference（χ2=6.668，P>0.05）. CRPA infections mainly came from neurosurgery, respiratory medicine and ICU, the proportion of CRPA in ICU patients was significantly higher than that in CSPA group, and the difference was statistically significant(χ2=6.686，P<0.05). The resistance rate of CRPA group to 12 kinds of antibiotics was significantly higher than that in CSPA group(χ2=10.500~55.185，all P<0.05), the mortality rate in CRPA group (25.0%) was significantly higher than that in CSPA group (10.9%), and the difference was statistically significant (χ2=6.400，P<0.05). Besides, multivariate logistic regression analysis showed that mechanical ventilation, use of 3,4 generation cephalosporins, use of carbapenem antibiotics, multidrug combination and staying in ICU within 14 days before infection were independent risk factors for CRPA nosocomial infection （all P<0.05,and OR>1）. Conclusion　CRPA infections in this hospital has high drug resistance rate and poor prognosis, and relatively high proportion of ICU. CRPA infections has multiple independent risk factors, and strengthening of these risk factors can effectively prevent the spread of CRPA.

参考文献/References:

[1] RAHAL J J. The role of carbapenems in initial therapy for serious Gram-negative infections[J].Crit Care. 2008,12 （Suppl4）:S5.
[2] 康月茜, 张任飞, 张婧, 等. 耐碳青酶烯铜绿 假单胞菌的分布及耐药分析[J]. 实验与检验医 学,2019,37(4):676-678. KANG Yueqian, ZHANG Renfei, ZHANG Jing, et al. Distribution and drug resistance of carbapenem resistant Pseudomonas aeruginosa[J].Experimental and Laboratory Medicine, 2019,37(4):676-678.
[3] 曾婷, 曾凌, 曹先伟, 等. 耐碳青霉烯类铜绿假单 胞菌耐药基因与药敏分析[J]. 中华医院感染学杂 志,2019,29(20):3063-3067. ZENG Ting,ZENG Ling,CAO Xianwei, et al. Antimicrobial susceptibility and resistance genes of carbapenem-resistant Pseudomonas aeruginosa[J]. Chinese Journal of Nosocomiology,2019, 29(20):3063- 3067.
[4] TACCONELLI E, CARRARA E, SAVOLDI A, et al. Discovery,research,and development of new antibiotics:the WHO priority list of antibiotic-resistant bacteria and tuberculosis[J]. Lancet Infectious Diseases, 2018, 18(3): 318-327.
[5] 中华人民共和国卫生部. 医院感染诊断标准（试行） [J]. 中华医学杂志,2001,81（5）:314-320. Ministry of Health of the People,s Republic of China. Diagnostic criteria for nosocomial infection (Trial) [J]. National Medical Journal of China, 2001,81 (5): 314-320.
[6] 尚红，王毓三，申子瑜. 全国临床检验操作规程[S]. 北京: 人民卫生出版社，2015:629-646. SHANG Hong, WANG Yusan, SHEN Ziyu. National Clinical Laboratory Procedure[S].4th ed. Beijing: People’s Health Publishing House,2015:629-646.
[7] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, Twenty-seventh informational supplement[S]. Wayne:PA,CLSI Docunent M100-S25,2017.
[8] 谢朝云, 熊芸, 覃家露, 等. 耐碳青霉烯类铜绿假单 胞菌的感染特征和危险因素分析[J]. 中国抗生素杂 志,2018,43(7):905-909. XIE Chaoyun, XIONG Yun, QIN Jialu, et al. Analysis of infection characteristics and risk factors of carbapenem resistant Pseudomonas aeruginosa[J]. Chinese Journal of Antibiotics, 2018,43(7):905-909.
[9] 余湛, 王军, 何飞, 等. 2015~2017 年重症监护病房 患者分离菌监测及耐药性分析[J]. 南京医科大学学 报( 自然科学版),2019,39(8):1229-1234. YU Zhan, WANG Jun, HE Fei, et al.Surveillance and drug resistance analysis of isolates from ICU patients in 2015~2017[J].Journal of Nanjing Medical University(Natural Sciences),2019,39(8):1229-1234.
[10] CHUNG D R, SONG J H, KIM S H, et al. High prevalence of Multidrug-Resistant nonfermenters in hospital-acquired pneumonia in Asia[J]. Am J Respir Crit Care Med , 2011, 184(12): 1409-1417.
[11] 袁莉莉, 丁百兴, 沈震, 等. 碳青霉烯类抗生素耐药 铜绿假单胞菌感染的临床研究[J]. 中国感染与化疗 杂志,2017,17(2):121-126. YUAN Lili, DING Baixing, SHEN Zhen, et al. Clinical investigation of infections caused by carbapenem-resistant Pseudomonas aeruginosa in Huashan Hospital[ J].Chinese Journal of Infection and Chemotherapy, 2017,17(2):121-126.
[12] LIU Qianqian, LI Xiaoqing, LI Wenzhang, et al. Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosa infection:a meta-analysis[J]. Scientific Reports, 2015, 5:11715.
[13] 王明贵. 广泛耐药革兰阴性菌感染的实验诊断、抗 菌治疗及医院感染控制：中国专家共识[ Ｊ ]. 中国 感染与化疗杂志,2017,17(1):82-92. WANG Minggui. Laboratory diagnosis, clinical m a n a g e m e n t a n d i n f e c t i o n c o n t r o l o f t h e infections caused by extensively drug-resistant Gram-negative baci l l i : a Chinese consensus statement[J]. Chinese Journal of Infection and Chemotherapy,2017,17(1):82-92.
[14] MENSA J, BARBER?N J, SORIANO A, et al. Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa:Guidelines by the Spanish Society of Chemotherapy[J]. Revista Espanola de Quimioterapia 2018, 31(1): 78-100.
[15] 罗赛赛, 郑巧伟, 董亚琳, 等. 我院2013~2016 年耐 碳青霉烯类铜绿假单胞菌医院感染的危险因素与临 床结局分析[J]. 中国药房,2018,29(5):667-670. LUO Saisai, ZHENG Qiaowei, DONG Yalin, et al. Analysis of risk factors and clinical outcome for carbapenems-resistant Pseudomonas aeruginosa infections in our hospital from 2013 to 2016[J].China Pharmacy, 2018,29(5):667-670.
[16] RAMAN G, AVENDANO E E, CHAN J, et al. Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis[J]. Antimicrob Resist Infect Control, 2018, 7: 79.
[17] 王娜, 贾俐萍, 王莉, 等. 医院耐碳青霉烯类铜绿假 单胞菌的流行及相关因素分析[J]. 中国医院药学杂 志,2016,36(02):138-141. WANG Na,JIA Liping,WANG Li, et al. Analysis o f p r e v a l e n c e a n d c o r r e l a t i o n f a c t o r s f o r carbapenem-resistant Pseudomonas aeruginosa in an hospital[J]. Chinese Journal of Hospital Pharmacy,2016,36(02):138-141.

备注/Memo

备注/Memo:
作者简介：吴志农（1984-），男，硕士研究生，主管技师，研究方向：细菌耐药监测及耐药机制研究，E-mail：343463657@qq.com。
通讯作者：周汉义，副主任技师，E-mail：zzx54123@163.com。
更新日期/Last Update: 2020-10-30