我院2013-2016年耐碳青霉烯类铜绿假单胞菌医院感染的危险因素与临床结局分析
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篇名: | 我院2013-2016年耐碳青霉烯类铜绿假单胞菌医院感染的危险因素与临床结局分析 |
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摘要: | 目的:探讨耐碳青霉烯类铜绿假单胞菌(CRPA)医院感染的危险因素与临床结局,为预防和治疗CRPA医院感染提供参考。方法:应用回顾性调查方法,收集我院2013-2016年CRPA与碳青霉烯类敏感铜绿假单胞菌(CSPA)医院感染患者的病历资料。采用单因素分析来判断CRPA医院感染危险因素,采用多因素Logistic回归分析来判断CRPA医院感染危险因素与死亡的相关性。结果:共收集铜绿假单胞菌感染病例556例,其中CRPA感染病例96例,占17.3%。对CRPA医院感染相关因素进行多因素Logistic回归分析显示,分离出铜绿假单胞菌前入住重症监护室(ICU)>3 d[OR=2.691,95%CI(1.348,5.373),P=0.005]、使用第三或四代头孢菌素[OR=0.386,95%CI(0.200,0.742),P=0.004]、合并其他病原菌感染[OR=1.892 ,95%CI(1.132,3.164),P=0.015]、联用2种以上抗菌药物[OR=5.631,95%CI(2.556,12.407),P=0.000]为CRPA医院感染的独立危险因素。临床结局分析,CRPA组的死亡率为12.5%,显著高于CSPA组的死亡率(2.8%)。Logistic回归分析结果显示,死亡率[OR=5.003,95%CI(1.975,12.675),P=0.001]与CRPA医院感染之间存在相关性。结论:预防CRPA医院感染,应降低患者入住ICU时间,根据患者病原菌结果合理选择使用抗菌药物,以降低CRPA医院感染的发生。 |
ABSTRACT: | OBJECTIVE: To investigate the risk factors and clinical outcome for carbapenems-resistant Pseudomonas aeruginosa (CRPA) infection, and to provide reference for the prevention and treatment of CRPA infection. METHODS: In retrospective investigation, medical records of CRPA and carbapenems-sensitive Pseudomonas aeruginosa (CSPA) infection were collected from our hospital during 2013-2016. CRPA infection risk factors were judged by single factor analysis. The relationship of CRPA risk factors and death was judged by multivariate Logistic regression analysis. RESULTS: A total of 556 cases of P. aeruginosa infection were collected, including 96 cases of CRPA injection, accounting for 17.3%. Multivariate Logistic regression analysis of related factors of CRPA infection showed that independent risk factors of CRPA infection included admission to ICU for more than 3 days before the isolation of P. aeruginosa [OR=2.691, 95%CI (1.348,5.373),P=0.005], the use of third-generation or fourth-generation cephalosporin [OR=0.386,95%CI (0.200,0.742),P=0.004], complicated with other pathogenic bacteria infection [OR=1.892,95%CI (1.132,3.164),P=0.015], combined with 2 kinds of antibiotics or above [OR=5.631,95%CI (2.556,12.407),P=0.000]. Clinical outcome analysis, mortality rate of CRPA infection were 12.5%, significantly higher than CSPA infection (2.8%), Logistic regression analysis, there is a correlation between death rate [OR=5.003, 95%CI (1.975,12.675), P=0.001] and CRPA infection. CONCLUSIONS: For the prevention of CRPA nosocomial infection, it is necessary to reduce the time of ICU stay and rationally select antibiotics according to pathogenic bacteria so as to reduce the occurrence of CRPA infection. |
期刊: | 2018年第29卷第5期 |
作者: | 罗赛赛,郑巧伟,董亚琳,魏友霞 |
AUTHORS: | LUO Saisai,ZHENG Qiaowei,DONG Yalin,WEI Youxia |
关键字: | 碳青霉烯类;铜绿假单胞菌;危险因素;死亡率 |
KEYWORDS: | Carbapenem; Pseudomonas aeruginosa; Risk factor; Mortality rate |
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