ICU患者耐碳青霉烯类革兰阴性菌感染的危险因素及耐药性分析

目的观察ICU患者耐碳青霉烯类革兰阴性菌感染的病原菌分布及耐药性,分析感染的危险因素。方法选取山东省潍坊医学院附属寿光市人民医院2015年2月-2019年2月ICU收治并感染耐碳青霉烯类革兰阴性菌患者210例作为研究组,分析患者感染部位与病原菌分布及耐药性。另选取同期ICU收治的未感染耐碳青霉烯类革兰阴性菌患者210例作为对照组。单因素及多因素Logistic回归分析患者耐碳青霉烯类革兰阴性菌感染的危险因素。结果210株耐碳青霉烯类革兰阴性菌,主要包括鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌等;标本类型主要为痰液,其次为血液、尿液;鲍氏不动杆菌除对左氧氟沙星、阿米卡星、替加环素、头孢哌酮-舒巴坦、多黏素耐药率相对较低外,对其他药物耐药率均较高;而阿米卡星、左氧氟沙星、多黏菌素、替加环素等则对肺炎克雷伯菌表现出高抗菌活性;铜绿假单胞菌对头孢替坦、头孢唑林、氨曲南与哌拉西林的耐药率均>90.0%。多因素Logistic分析结果,二次插管、抗菌药物联用、应用碳青霉烯类抗菌药物、白蛋白水平低、脑血管病是发生感染的危险因素。结论鲍氏不动杆菌、肺炎克雷伯菌是ICU主要耐碳青霉烯类革兰阴性菌,病原菌多药耐药情况严重,感染与二次插管、低蛋白血症、碳青霉烯类抗菌药物使用、多联抗菌药物使用、合并脑血管病等因素有关,这类患者应引起临床重视。

Risk factors for carbapenem-resistant gram-negative bacteria infections in ICU patients and drug resistance

OBJECTIVE To observe the distribution and drug resistance of carbapenem-resistant gram-negative bacteria causing infections in ICU patients and analyze the risk factors for the infections.METHODS Totally 210 patients with carbapenem-resistant gram-negative bacteria infections who were treated in ICUs of Shouguang People′s Hospital Affiliated to Weifang Medical College from Feb 2015 to Feb 2019 were chosen as the study group,the infection sites,distribution of pathogens and drug resistance were analyzed.Meanwhile,210 patients without carbapenem-resistant gram-negative bacteria infections who were treated in the ICUs were set as the control group.Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the carbapenem-resistant gram-negative bacteria infections.RESULTS Among 210 strains of carbapenem-resistant gram-negative bacteria,Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were dominant.Sputum was the predominant type of specimens,followed by blood and urine specimens.The drug resistance rates of the A.baumannii strains to levofloxacin,amikacin,tigecycline,cefoperazone-sulbactam and polymyxin were relatively low,while the drug resistance rates to other antibiotics were high.Amikacin,levofloxacin,polymyxin and tigecycline showed high antibacterial activity against the K.pneumoniae strains.The drug resistance rates of the P.aeruginosa strains to cefotetan,cefazolin,aztreonam and piperacillin were more than 90.0%.The multivariate logistic analysis showed that secondary intubation,use of multiple antibiotics,use of carbapenem antibiotics,low expression of albumin,and cerebrovascular disease were the risk factors for the infections.CONCLUSION A.baumannii and K.pneumoniae are dominant among the carbapenem-resistant gram-negative bacteria isolated from the ICU patients,the pathogens are highly multidrug-resistant.The infections are associated with the secondary intubation,hypoproteinemia,use of carbapenems,use of multiple antibiotics and complication with cerebrovascular disease,to which the hospital should pay great attention.