多重耐药铜绿假单胞菌感染的危险因素与合理用药的研究

目的：探讨多重耐药铜绿假单胞菌（MDRP）医院感染的危险因素与耐药性分析，为临床合理用药提供科学依据。方法对临床标本分离的586株铜绿假单胞菌采用黑马迪尔的96NE板进行药敏试验，分析其耐药性，并对其感染的危险因素采用单因素分析（χ2检验与t检验）和多因素分析logistic回归方法进行分析。结果586株铜绿假单胞菌中多重耐药菌有84株（占14.3%）。单危险因素及多危险因素分析得出既往入住ICU治疗、机械介入、使用碳青霉烯类抗菌药物是多重耐药铜绿假单胞菌感染的独立危险因素。12种常用抗菌药物中，多重耐药铜绿假单胞菌对头孢哌酮/舒巴坦的耐药率最低，为27.4%，对庆大霉素和环丙沙星的耐药率最高，分别为90.5%、92.9%。多重耐药铜绿假单胞菌对头孢他啶的耐药率由2008年的61.5%下降到2012年的39.1%，对亚胺培南、美罗培南和替卡西林/克拉维酸的耐药率由2008年的38.5%、38.5%、46.2%上升到2012年的52.2%、52.2%、78.3%。结论多重耐药铜绿假单胞菌的耐药性已十分严重，临床应重视监测药敏结果，根据药敏结果合理使用抗菌药物，同时还应重视多重耐药铜绿假单胞菌感染的各种危险因素，以减少和控制细菌耐药的发生。

Study on the risk factors of multiple drug-resistant Pseudomonas aeruginosa infection and the rational use of antimicro- bial agents

Objective To investigate the risk factors and drug-resistance of Pseudomonas aeruginosa in nosocomial infections and provide the scientific evidence for the clinical use of the antibiotics. Methods A total of 586 strains of Pseudomonas aerugi-nosa isolated from clinical specimens were conducted drug sensitivity test by using 96NE plate from Black Madill＇s company, and the drug resistance of these strains were analyzed. The statistical analyses of the single factor analysis （χ2 and t test） and multivari-ate logistic regression methods were used to analyze the risk factors of multidrug drug-resistant Pseudomonas aeruginosa infection. Results There were 84 strains of multidrug resistant Pseudomonas aeruginosa in the 586 strains of Pseudomonas aeruginosa, which accounted for 14.3%. Previous treatment in the ICU, mechanical intervention procedures, and the use of carbapenem antibiotics were the independent risk factors of infection of multiple drug resistant Pseudomonas aeruginosa. Among the 12 kinds of antibi-otics, the drug-resistance rate of multiple drug-resistance Pseudomonas aeruginosa to cefoperazone/sulbactam was the lowest （27.4%）. And the drug-resistance rate to gentamicin and ciprofloxacin were 90.5%and 92.9%, respectively, which were the high-est. The drug resistance rate of multiple drug-resistance Pseudomonas aeruginosa to ceftazidime fell from 61.5%in 2008 to 39.1%in 2012. And the drug-resistance rates to imipenem, meropenem and ticarcillin/clavulanic increased from 38.5%, 38.5% and 46.2%in 2008 to 52.2%, 52.2%and 78.3%in 2012, respectively. Conclusions The drug-resistance rates of multiple drug-resis-tance Pseudomonas aeruginosa are very serious. In order to reduce and control the occurrence of multiple drug-resistance bacteria, clinician should use antibiotics rationally according to the results of drug susceptibility test and pay attention to the various risk factors of multiple drug-resistant Pseudomonas aeruginosa infection.