监护病房与普通病房下呼吸道铜绿假单胞菌感染的临床和耐药性对比研究

目的 通过对比重症监护病（ICU）与普通病房下呼吸道铜绿假单胞菌（PA）感染的临床资料和细菌耐药性,为临床合理防治提供依据。方法 分析1997年5月-2001年12月间发生于ICU和普通病房的323例（ICU163例,普通病房160例）下呼吸道PA感染患者的临床资料及自下呼吸道标本分离出的1387株PA（ICU879株,普通病房508株）的体外药敏活性。结果 323例患者的基础疾病较重,以慢性阻塞性肺疾病合并呼吸衰竭（23.31%的ICU患者和12.50%的普通病房患者）和恶性肿瘤（14.72%的ICU患者和14.38%的普通病房患者）最多。易患因素多而复杂,尤其侵袭性操作ICU明显多于普通病房,ICU较普通病房耐药率高,2000年后药物敏感性明显下降。药敏试验结果显示,PA对头孢哌酮-舒巴坦,哌拉西林-三唑巴坦,职权米卡星,头孢他啶,头孢吡肟,亚胺培南,哌拉西林,头孢哌酮,替卡西林-克拉维酸,环丙水利生的耐药率依次为1.0%,2.5%,6.1%,9.2%,11.3%,13.5%,13.8%,16.4%,17.2%及20.2%,ICU患者治疗效果差,病死率高。结论 PA致下呼吸道感染大多发生于免疫功能低下患者,各种易感因素促成本病发生,PA对常用抗生素亦存在一定耐药性,临床应根据药物敏感性选用抗生素。

A control study on bacterial resistance and clinical features of lower respiratory tract infection with Pseudomonas aeruginosa in medical intensive care unit and general ward

Objective To compare the bacterial resistance and clinical features of lower respiratory tact infection with Pseudomonas aeruginosa (PA) in medical intensive care units (MICU) and general wards (GW) and to analyze the predisposing factors to PA infection Methods Three hundred and twenty three patients with lower respiratory tract PA infection , aged from 30 to 91 years, admitted into Shanghai Zhongshan hospital from May 1997 to December 2001( 163 in MICU and 160 in GW) were included in this retrospective study The predisposing factors, underlying diseases, clinical presentations, laboratory data, treatment and outcome of these patients were analyzed On the other hand, the susceptibility patterns to antibiotics of 1 387 PA strains (879 from MICU and 508 from GW) from the recorders of the bacteria culture chamber were investigated Results The underlying diseases of the patients mainly were chronic obstructive pulmonary disease (23 3% of patients in MICU and 12 5% in GW) and malignant tumor (14 7% in MICU and 14 4% in GW) A relatively high resistant rates of PA strains to common antibiotics were found in both groups: cefoperazone/sulbactam 1 0% (MICU:1 0%, GW:1 1%), piperacillin/tazobactam 2 5%(MICU:1 0%, GW:5 0%), amikacin 6 1%(MICU:7 0%, GW:4 5%), ceftazidime 9 2%(MICU:11 6%, GW:2 7%), cefepime 11 3%(MICU:12 2%, GW:10 8%), imipenem 13 5%(MICU:6 8%, GW:25 2%), piperacillin 13 8%(MICU:17 8%, GW:6 9%), cefoperazone 16 4%(MICU:22 1%, GW:6 6%), ticarcillin/clavulanicacid 17 2%(MICU:21 2%, GW:17 3%), cidomycin 18 5%(MICU:20 5%, GW:14 9%), ciprofloxacin 20 2%(MICU:27 2%, GW:8 1%), ceftriaxone 44 4%(MICU:53 6%, GW:28 4%) Most of the resistant rates of strains from MICU were higher than those from GW The susceptibilities of PA to ceftazidime and piperacillin changed little during the past 5 years and were above 80 00% Since 1988, especially from 2000,the susceptibility of PA to most antibiotics became remarkably lower With selected antibiotic treatment of the infections 196 patients were cured, 79 patients died in hospital The mortality of patients in GW(16 25%, 26/160) was lower than that in MICU (32 52%, 53/163) Conclusion Precautions to PA infection is important in patients with predisposing factors Patients with Lower respiratory tract PA infection in MICU had different clinical features, laboratory data and outcome compared to GW patients The PA isolated from MICU patients had a higher resistant rate to many antibiotics than that from GW patients It is important to perform antibiotic sensitivity test timely to help correct selection of drugs, especially for MICU patients