多药耐药铜绿假单胞菌院内感染危险因素及预后因素分析

目的 分析多药耐药铜绿假单胞菌(MDRP)产生的危险因素，并探讨影响MDRP院内感染预后的因素。方法 采用病例对照研究方法。收集北京协和医院1999年1月～2002年12月MDRP引起的院内感染44例，并随机选择同时期敏感铜绿假单胞菌院内感染68例作为对照，采用单因素(t检验，χ^2检验)及多因素Logistic回归进行分析。结果 对112例铜绿假单胞菌院内感染单因素分析发现，下列因素与MDRP感染有关：高龄、高APACHE Ⅱ(acute physiology and chronic health evaluation)评分、2种以上细菌混合感染、院内获得性肺炎(HAP)、机械通气、患有慢性阻塞性肺疾病(COPD)、分离出MCIRP前15天用过氟喹喏酮、分离出MDRP前15天用过亚胺培南／美罗培南。但多因素Logistic回归分析仅确定了2项独立危险因素：机械通气比值比(OR)=8．19]，分离出MDRP前15天用过亚胺培南／美罗培南(OR，44．80)。44例MDRP院内感染，死亡24例，好转20例，病死率为55％。单因素分析发现，下列因素与MDRP感染死亡相关：高APACHEⅡ评分、机械通气、未恢复对抗铜绿假单胞菌抗生素的敏感性。多因素Logistic回归分析发现了1项独立危险因素：未恢复对抗铜绿假单胞菌抗生素的敏感性(OR=10．70)。结论 机械通气，以及亚胺培南／美罗培南的使用是MDRP感染的危险因素。MDRP未恢复对抗铜绿假单胞菌抗生素的敏感性是MDRP感染预后差的危险因素。

Risk factors and clinical outcomes of nosocomial infections caused by multidrug resistant Pseudomonas aeruginosa

OBJECTIVE: To investigate the risk factors for multi-drug resistant Pseudomonas aeruginosa (MDRP) infections, and the factors related with poor prognosis of P. aeruginosa infections. METHODS: The data of 44 cases of MDRP nosocomial infections were analyzed from Jan, 1999. to Dec, 2002 in Peking Union Medical Hospital; 68 cases of antibiotic-sensitive P. aeuroginosa infection were randomized as control. T test, chi-square test and Logistic regression analysis were used for statistics. RESULTS: According to univariate analysis, the factors associated with the development of MDRP nosocomial infection were age, APACHE II, co-infection with other pathogens, hospital acquired pneumonia (HAP), mechanical ventilation, COPD, fluoroquinolone and imipenem/meropenem use 15 days before isolation of MDRP. Multivariate logistic regression analysis identified two independent factors: mechanical ventilation and previous imipenem/meropenem use. Of 44 cases of MDRP infections, 24 died, and 20 survived. Univariate analysis revealed that three factors (APACHE II, mechanical ventilation, resistance switch) were associated with clinical prognosis. But a ccording to multivariate logistic regression analysis, only resistance switch was a predictive factor. CONCLUSIONS: Mechanical ventilation and previous imipenem/meropenem use were independent risk factors for MDRP infection. Resistance switch was a predictive factor for the prognosis of MDRP infection.