老年耐亚胺培南铜绿假单胞菌院内感染现状及危险因素分析

目的：探讨老年耐亚胺培南铜绿假单胞菌（IRPA）感染的危险因素以指导临床救治。方法：采用病例对照研究,选取四川省人民医院干部科2006年1月～2008年12月IRPA院内感染老年患者32例,并随机选择同时期敏感铜绿假单胞菌院内感染48例作为对照,采用单因素（t检验,x~2检验）及多因素Logistic回归进行分析。结果：IRPA分离率为34.8%,IRPA对抗生素的耐药性远远高于敏感铜绿假单胞菌组,但对阿米卡星敏感率达81.3%。单因素分析发现,下列因素与IRPA感染有关：高龄、住院时间≥4周、高急性生理和慢性健康状况（APACHEⅡ）评分、慢性肺部疾病（慢性阻塞性肺疾病COPD/支气管扩张）、分离出IRPA前2周用过亚胺培南/美罗培南、早期联用抗生素、院内获得性肺炎（HAP）。多因素Logistic回归分析表明：长程住院比值比（OR）=14.887],APACHEⅡ评分≥16分（OR=38.908）以及分离出IRPA前2周用过亚胺培南/美罗培南（OR=12.945）是IRPA感染的独立危险因素。结论：长程住院、APACHEⅡ评分≥16分以及亚胺培南/美罗培南的使用是IRPA感染的危险因素。IRPA对阿米卡星敏感率相对较高,但治疗难度大。

Infection Status and Risk Factors of Nosocomial Infections Caused by Imipenem-resistant Pseudomonas Aeruginosa

Objective：To study the infection status and risk factors of nosocomial infection caused by imipenem-resistant Pseudomonas aeruginosa（IRPA） in elderly patients.Methods：By a case-control study,the data of 32 cases of IRPA nosocomial infections were analyzed from Jan.2006.to Dec.2008 in cadres Ward of Sichuan Provincial People＇ s Hospital;48 cases of Imipenem-sensitive pseudomonas aeruginosa infection were randomized as control.Univariate analysis（T test and chi-square test ）and multivariate logistic regression analysis were used for statistics.Results：The resistance to antibiotics of IRPA is much higher than the sensitive group.81.3%of IRPA were sensitive to amikacin. According to univariate analysis,the factors associated with the infection caused by IRPA were age,length of stay in hospital more than 1 weeks,high score of APACHEⅡ,chronic pulmonary disease（COPD/bronchiectasis）,imipenem /meropenem used 2 weeks before isolation of IRPA,early combination therapy of antibiotics and hospital acquired pneumonia（HAP）.Multivariate logistic regression analysis identified three independent factors：Length of stay in hospital more than 4 weeks.APACHEⅡscore≥16 and imipenem/meropenem used 2 weeks before isolation of IRPA. Conclusion：Long length of stay in hospital,APACHEⅡscore≥16 and previous imipenem/meropenem use were independent risk factors for IRPA infection.Although the sensitivity of IRPA to amikacin was relatively high,it was difficult to treat in clinical practice.