耐亚胺培南铜绿假单胞菌致医院感染危险因素的病例对照研究

彭少华; 金正江; 罗兰; 李从荣

Abstract

彭少华,金正江,罗兰,李从荣.耐亚胺培南铜绿假单胞菌致医院感染危险因素的病例对照研究[J].Chinese journal of Epidemiology,2005,26(7):511-514

耐亚胺培南铜绿假单胞菌致医院感染危险因素的病例对照研究

A case control study on the risk factors of nosocomial infection caused by imipenem resistant Pseudomonas aeruginosa

Received:September 09, 2004

DOI：

KeyWord: 医院感染耐亚胺培南铜绿假单胞菌危险因素

English Key Word: Nosocomial infection Imipenem resistant Pseudomonas aeruginosa Risk factor

FundProject:湖北省卫生厅重点项目资助(WJ01564)

Author Name	Affiliation
PENG Shao-hua	Department of Laboratory Science, Renmin Hospital of Wuhan University, Wuhan 430060, China
JIN Zheng-jiang	Department of Laboratory Science, Renmin Hospital of Wuhan University, Wuhan 430060, China
LUO Lan	武汉大学公共卫生学院, 430060
LI Cong-rong	Department of Laboratory Science, Renmin Hospital of Wuhan University, Wuhan 430060, China

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Abstract:

目的探讨耐亚胺培南铜绿假单胞菌(IRPA)导致医院感染的危险因素。方法选取2002年1月至2003年12月收治的67例IRPA医院感染病例、150例亚胺培南敏感铜绿假单胞菌(ISPA)医院感染者为病例组,同时选取同一病区,接受相似治疗措施的非铜绿假单胞菌感染的住院患者为对照组,其中敏感对照组159例,耐药对照组200例。分别对两组患者的危险因素进行病例对照研究,采用非条件logistic回归分析法进行分析。结果多因素非条件logistic回归分析表明,IRPA医院感染的发生与住院时间长短(OR=1.03,95% CI:1.01～1.04)、亚胺培南(OR=4.65,95% CI:1.35～11.52)、哌拉西林/他唑巴坦(OR=3.37,95% CI:1.85～9.43)及喹诺酮类抗菌药物(OR=1.85,95% CI:1.25～5.34)的使用有关;而ISPA医院感染与三代头孢(OR=2.54,95% CI:1.26～5.23)及氨基糖苷类抗生素(OR=1.86,95% CI:1.42～3.26)的使用、住院时间长短(OR=1.05,95% CI:1.03～1.05)有关。结论为减少IRPA医院感染的发生,在限制使用亚胺培南的同时,应尽可能根据药物敏感试验的结果,合理使用其他抗菌药物。

English Abstract:

Objective To explore the risk factors for nosocomial infection caused by imipenem resistant Pseudomonas aeruginosa(IRPA). Methods A casecontrol study was carried out for the comparison of 2 groups of 'case' patients with 'controlled' patients. The first group of case patients had nosocomial isolation of IRPA, and the second group had imipenem susceptible Pseudomonas aeruginosa(ISPA). Control patients were selected from the same medical or surgical services from which case patients were receiving care when isolation of IRPA or ISPA occurred. Risk factors analyzed included the use of antimicrobials, comorbid conditions, and demo graphic variables. IRPA was recovered from 67 patients, and ISPA from 150 patients while the control case were 200 and 159 respectively. All patients were from Renmin Hospital of Wuhan University during Jan 2002 to Dec 2003. Data were analyzed with unconditional logistic regression and principal component analysis. Results Data from multivariate unconditional logistic regression analysis showed that the independent risk factors for IRPA nosocomial infection were: time at risk(OR = 1. 3, 95% CI:1.01-1. 04), imipenem(OR= 4.65, 95% CI:1.35-11.52), PIP/TAZ(OR=3.37, 95% CI:1.85-9.43) and quinolones(OR=1.85, 95% CI:1.25-5.34) while the third cephalospor ins(OR=2.54, 95% CI:1.26-5.23) and aminoglycoside ant ibiotics(OR=1.86, 95% CI:1.42 -3. 26), time at risk(OR=1.05, 95% CI:1.03-1.05) were associated with isolated ISPA. Conclusion Nosocomial infection of IRPA could be caused by the use of imipenem and other antibiotics, sugg esting that to limit the use of imipenem was not sufficient to contain the increasing incidence of IRPA.

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