摘要
调查近五年我院病原菌分布特点并分析感染耐碳青霉烯铜绿假单胞菌(CRPA)的危险因素以有效控制医院感染和多重耐药的发生,为临床合理治疗提供依据。回顾性分析2019年1月—2023年12月本院收治的200例院内感染患者的临床资料,探究其近5年病原菌分布特点;同时分析铜绿假单胞菌(PA)对碳青霉烯类药物的耐药率,应用单因素和多因素Logistic回归分析患者感染CRPA的危险因素。200例患者共检出病原菌339株,其中G^(-)菌分离207株(61.06%)、G^(+)菌分离102株(30.09%)、真菌分离30株(8.85%),前5位依次为PA、肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌、肠球菌属;近5年G^(-)菌、G^(+)菌、真菌分布趋势大体相同,均呈现2019—2021年下降,2021—2023年上升的趋势,其中以2021年分离率最低。本次研究共收集58株PA标本,其中CRPA分离22株(37.93%)、CSRA分离36株(62.07%);CRPA对亚胺培南、美罗培南耐药率高达100.00%,对头孢曲松、氨曲南的耐药率>70%,对阿米卡星、环丙沙星、庆大霉素、妥布霉素的耐药率<30%;CSRA除对头孢曲松耐药率>40%外,对其余抗菌药物耐药率均<20%;CRPA对亚胺培南、美罗培南、哌拉西林等抗菌药物的耐药率高于CSRA(P<0.05);依据患者是否感染CRPA将58株PA分为CRPA组(n=22)和CSRA组(n=36),单因素分析结果显示,合并侵入操作(气管切开、深静脉置管、机械通气)、入住ICU、使用抗菌药物≥2种、碳青霉烯类药物使用时间>7 d、使用头孢菌素药物、合并其他病原菌感染等因素与CRPA感染发生显著相关(P<0.05);多因素Logistic回归分析显示,机械通气、使用抗菌药物≥2种、碳青霉烯类药物使用时间>7 d是CRPA感染发生的危险因素(P<0.05)。近5年本院病原菌呈现先下降后上升的变化趋势,其中占比最高的PA耐药性较为严重,CRPA菌株检出率高,其感染的发生与机械通气、使用抗菌药物≥2种、碳青霉烯类药物使用时间>7 d等因素显著相关。
To investigate distribution characteristics of pathogenic bacteria in the hospital in recent five years and analyze the risk factors of carbapenem-resistant Pseudomonas aeruginosa(CRPA)infection,to effectively control the occurrence of nosocomial infection and multiple drug resistance,and to provide evidence for clinical rational treatment,a retrospective analysis was performed on the clinical data of 200 patients with nosocomial infection admitted to the hospital between January 2019 and December 2023.The distribution characteristics of pathogenic bacteria in the recent five years were explored.The resistance rate of Pseudomonas aeruginosa(PA)to carbapenems was analyzed,and the risk factors of CRPA infection were analyzed by univariate and multivariate Logistic regression analysis.In the 200 patients,there were 339 strains of pathogenic bacteria,including 207 strains of G^(-)bacteria(61.06%),102 strains of G^(+)bacteria(30.09%)and 30 strains of fungi(8.85%).The top 5 pathogenic bacteria were PA,Klebsiella pneumoniae,Staphylococcus aureus,Escherichia coli and Enterococcus.In the recent five years,the distribution trends of G^(-)bacteria,G^(+)bacteria and fungi were generally same,all of them showed a downward trend from 2019 to 2021 and an upward trend from 2021 to 2023,with the separation rate in 2021 being the lowest.In the 58 strains of PA specimens,there were 22(37.93%)strains of CRPA and 36(62.07%)strains of carbapenem sensitivity rate of antibiotics(CSRA).The resistance rates of CRPA to imipenem and meropenem were as high as 100.00%,to ceftriaxone and aztreonam were both>70%,and to amikacin,ciprofloxacin,gentamicin and tobramycin were all<30%.The drug resistance rate of CSRA to ceftriaxone was>40%,and to the other antibiotics was all<20%.The resistance rates of CRPA to imipenem,meropenem and piperacillin were higher than those of CSRA(P<0.05).According to presence or absence of CRPA infection,58 strains of PA were divided into CRPA group(n=22)and CSRA group(n=36).The results of single factor analysis showed that the combination of invasive operation(tracheotomy,deep vein catheterization,mechanical ventilation),ICU admission,use of≥2 kinds of antibiotics,usage duration of carbapenems>7 days,use of cephalosporins,and combination of other pathogens were significantly correlated with the incidence of CRPA infection(P<0.05).Multivariate Logistic regression analysis showed that mechanical ventilation,use of≥2 kinds of antibiotics and usage duration of carbapenems>7 days were the risk factors of CRPA infection(P<0.05).In recent 5 years,the pathogenic bacteria in the authors'hospital showed a trend of decreasing first and then increasing,among which the resistance of PA,which accounted for the highest proportion,was more serious,and the detection rate of CRPA was high.The occurrence of its infection was significantly correlated with mechanical ventilation,the use of≥2 kinds of antibiotics,and the use time of carbapenems>7 days.
作者
崔俊丽
刘敏
田小晶
许美娟
CUI Junli;LIU Min;TIAN Xiaojing;XU Meijuan(Department of Pharmacy,Dongtai People's Hospital,Dongtai 224200,China)
出处
《药物生物技术》
2025年第3期290-295,共6页
Pharmaceutical Biotechnology
基金
江苏省老年医学学会2023年度临床药学专项基金(No.JGS2023ZDYX014)。
关键词
病原菌
分布特点
铜绿假单胞菌
碳青霉烯类药物
耐药率
耐碳青酶烯类铜绿假单胞菌
危险因素
Pathogenic bacteria
Distribution characteristic
Pseudomonas aeruginosa
Carbapenem
Drug resistance rate
Carbapenase-resistant Pseudomonas aeruginosa
Risk factor
