碳青霉烯耐药铜绿假单胞菌医院获得性肺炎的危险因素及预后分析.docVIP

碳青霉烯耐药铜绿假单胞菌医院获得性肺炎的危险因素及预后分析 陈娜 赵敏 河南大学淮河医院 开封 邮编 475000 【摘要】目的　探讨耐碳青霉烯铜绿假单胞菌医院获得性肺炎（HAP）的危险因素及预后影响因素。方法　采用病例对照研究，收集耐碳青霉烯铜绿假单胞菌引起的医院获得性肺炎48例，并选择同时期碳青霉烯敏感的铜绿假单胞菌HAP 104例作为对照，采用X2检验进行分析。结果　感染前APACHEⅡ评分(16分)、入住ICU(3 d)、合并其他细菌感染、气管切开或插管、留置胃管、联合使用多种抗生素是导致耐碳青霉烯铜绿假单胞菌HAP发生的危险因素；多因素Logistic回归分析发现，APACHEⅡ评分≥16分、联合使用抗生素3种是独立危险因素；合并其他细菌感染以及呼吸衰竭是影响耐碳青霉烯铜绿假单胞菌HAP患者预后的因素。结论 严格把握入住ICU、气管切开及抗生素使用指征等对防止碳青霉烯耐药铜绿假单胞菌HAP极为重要。 【关键词】铜绿假单胞菌；医院获得性肺炎；碳青霉烯耐药；危险因素；预后因素 Risk Factors and Prognosis of Hospital Acquired Pneumonia Caused by Carbapenem-Resistant Pseudomonas Aeruginosa 【Abstract】Objective　To study the risk factors and prognosis of hospital acquired pneumonia（HAP）caused by Carbapenem-resistant Pseudomonas Aeruginosa. Methods　By a case-control study, the data of 48 cases of HAP caused by Carbapenem-resistant Pseudomonas Aeruginosa were analyzed. 104 cases of HAP caused by Carbapenem-susceptible Pseudomonas Aeruginosa were selected at the same time as control. Chi-square test was used for statistics. Results　 APACHE score16, ICU stay3d, tracheotomy or tracheal intubation, gastric tube intubation, and combined use of antibiotics were risk factors for HAP caused by Carbapenem-resistant Pseudomonas Aeruginosa. Multivariate logistic regression analysis identified two independent factors as APACHEⅡscore16 and combined use of antibiotics. Co-infection of other bacteria and respiratory failure were predictive factors. Conclusions　It is important to prevent HAP caused by Carbapenem-resistant Pseudomonas Aeruginosa by strict limitation on the indication of ICU stay, tracheotomy and use of antibiotics. 【Key words】Pseudomonas Aeruginosa; Hospital acquired pneumonia; Carbapenem-resistant; Risk factors; Prognostic factors 医院获得性肺炎(hospital acquired pneumonia，HAP)是最常见的医院内获得性感染，是住院患者死亡的重要原因。铜绿假单胞菌是一种重要的院内获得性感染致病菌。2003年美国疾病控制中心院内感染监测(NNIS)报告指出：铜绿假单胞菌在所有院内感染致病菌中排第5位，在革兰阴性菌中排第2位，在非发酵菌中排第1位[1]。我国全国性革兰阴性菌耐药监测(NPRS)数据显示，截至2001年在所有院内感染革兰阴性杆菌中，铜绿假单胞菌占第1位[2]。铜绿假单胞菌广泛存在医院环境中，致病毒力强，且其对碳青霉烯耐药性在不断升高，