西安地区耐亚胺培南铜绿假单胞菌感染危险因素

摘要

目的：分析某地区耐亚胺培南铜绿假单胞菌（IRPA）感染的危险因素，为控制 IRPA 感染提供参考。方法随机选取西安地区4所三级医院2013年2-10月IRPA感染患者103例（病例组），同期对亚胺培南敏感的铜绿假单胞菌感染患者103例（对照组），对IRPA感染危险因素进行分析。结果单因素分析结果显示：高龄、住院时间≥4周、慢性肺部疾病、入住重症监护室、机械通气、分离出IRPA前2周使用过亚胺培南或美罗培南等碳青霉烯类抗生素、早期联合应用抗菌药物是IRPA感染的相关危险因素；选取单因素分析有统计学意义的变量进行logistic多因素回归分析，结果显示，住院时间≥4周（OR95％ CI：1．44～139．73）、机械通气（OR95％ CI：2．96～267．75）以及分离出IRPA前2周使用过亚胺培南或美罗培南（OR95％ CI：2．65～154．34）是IRPA 感染的独立危险因素。结论该地区医院应针对IRPA感染危险因素进行干预，以期降低IRPA感染的风险。%Objective To investigate the risk factors for imipenem-resistant Pseudomonas aeruginosa (IRPA)infections in Xi’an,and provide reference for the control of IRPA infections .Methods 103 IRPA patients who were hospitalized at 4 hospitals in Xi’an between February and October 2013 were randomly selected(case group),103 imipenem-susceptible Pseudomonas aeruginosa-infected patients during the same hospitalization period were as control group,risk factors for IR-PA infection were analyzed.Results Univariate analysis revealed that old age,length of hospital stay≥4 weeks,chronic pulmonary diseases,stay in intensive care unit,mechanical ventilation,use carbapenems (imipenem,meropenem)2 weeks before the isolation of IRPA ,and early combination of antimicrobial drugs were related risk factors for IRPA infection;Lo-gistic multivariate analysis showed that length of hospital stay≥4 weeks(OR95% CI:1.44-139.73),mechanical ventila-tion(OR95% CI:2.96-267.75),and use carbapenems (imipenem,meropenem)2 weeks before the isolation of IRPA (OR95% CI:2.65-154.34)were independent risk factors for IRPA infection.Conclusion IRPA infection in patients in this area should be intervened to reduce risk factors for IRPA infection.