耐亚胺培南铜绿假单胞菌感染耐药性及危险因素分析

摘要

Objective To explore the drug resistance and risk factors of imipenem-resistant Pseudomonas aeruginosa infections in order to provide evidence and reference for clinical prevention and treatment.Methods The drug resistance and risk factors of imipenem-resistant Pseudomonas aeruginosa isolated from January 2015 to December 2016 were retrospectively analyzed.Results A total of 798 strains of Pseudomonas aeruginosa were isolated,of which 217 strains of imipenem-resistant Pseudomonas aeruginosa resistant to imi-penem were isolated,and the isolation rate was about 27.2％.The main source of specimen was sputum(71.9％).The infected patients were mainly from the intensive care unit(ICU)(52.1％).The resistant rate to Amikacin was the lowest(10.1％)followed by gentamicin(29.5％),and the other resistance rates were more than 45.0％;the resistance rate of imipenem-resistant Pseudomonas aeruginosa to common antibiotics was significantly higher than that of non imipenem-resistant Pseudomonas aeruginosa,the difference was sta-tistically significant(P＜0.05).The main risk factors for imipenem resistant Pseudomonas aeruginosa infec-tion were venerable age,hospitalized for more than 2 weeks,using antibiotics for more than 2 weeks,using car-bapenems,diabetes,ICU,mechanical ventilation,deep vein catheterization,indwelling catheterization and co-ma.Conclusion The surveillance of drug resistance of imipenem resistant Pseudomonas aeruginosa should be strengthened,and the prevalence of drug-resistant bacteria should be intervened,prevented and controlled in hospitals.%目的 探讨耐亚胺培南铜绿假单胞菌感染的耐药特点及危险因素,为临床防治提供相关依据和参考.方法 回顾性分析2015年1月至2016年12月临床分离的耐亚胺培南铜绿假单胞菌耐药情况及发生感染的相关危险因素.结果 共分离铜绿假单胞菌798株,其中耐亚胺培南铜绿假单胞菌217株,分离率为27.2％;标本来源以痰液为主,占71.9％,感染患者主要来自重症监护病房(ICU),占52.1％;对阿米卡星耐药率最低(10.1％),其次为庆大霉素(29.5％),其余耐药率均超过45.0％;耐亚胺培南铜绿假单胞菌对常用抗菌药物耐药率明显高于非耐亚胺培南铜绿假单胞菌,差异有统计学意义(P＜0.05);高龄、住院时间超过2周、使用抗菌药物超过2周、使用过碳青霉烯类、糖尿病、入住ICU 、机械通气、深静脉置管、留置导尿、昏迷等是耐亚胺培南铜绿假单胞菌感染的主要危险因素.结论 应加强耐亚胺培南铜绿假单胞菌耐药性监测,针对感染危险因素进行干预、预防及控制耐药菌株在医院内流行.