摘要
目的探讨医院感染性肺炎泛耐药铜绿假单胞菌（PDRPA）感染的危险因素。方法采用病例对照研究方法，病例组收集2001年1月-2005年12月住院的27例PDRPA引起的医院感染性肺炎病例，并随机选择同时期非PDRPA感染的医院感染病例27例作为对照组；单因素分析采用t检验或Х^2检验，多因素分析采用Logistic回归分析。结果单因素分析发现感染前住院时间、入住ICU、APACHEII评分、机械通气、体内留置导管（包括尿管、胃管、中心静脉导管和动脉导管）、纤维支气管镜吸痰和使用抗菌药物数量与PDRPA感染有关；Logistic多因素回归分析发现只有机械通气（OR5．705；95％CI：1．205～27．007；P=0．028）、使用抗菌药物数量（OR3．173；95％CI：1．472～6．841；P=0．003）和APACHEⅡ评分≥16（OR6．390；95％CI：1．191～34．281；P=0．021）为独立危险因素。结论机械通气、抗菌药物数量和APACHE Ⅱ评分≥16是PDRPA医院感染性肺炎的重要危险因素，对于病情严重的肺部感染患者，特别是需要机械通气的患者，严格执行消毒制度并且合理地使用抗菌药物，尽量减少PDRPA的发生率，才是治疗的关键。
OBJECTIVE To evaluate the risk factors of pan-drug-resistant Pseudomonas aeruginosa （PDRPA） and non-PDRPA bacteremia. METHODS Twenty seven patients with PDRPA and twenty seven matched patients with non-PDRPA were analyzed from 2001 to 2005 in The Guangzhou First Municipal People＇s Hospital Affiliated to Guangzhou Medical College. A matched case-control study was conducted. T test, ehi-square test and Logistic regression analysis were used for statistics. RESULTS For univariate analysis, the factors associated with nosocomial pneumonia due to PDRPA were the length of hospital stay before acquisition of P. aeruginosa, admitted to ICU before acquisition of P. aeruginosa, invasive procedures, mechanical ventilation, the number of prescribed antibiotics and APACHE Ⅱ score. Multivariate Logistic regression analysis identified three independent risk factors associated with nosocomial pneumonia due to PDRPA： mechanical ventilation （OR5. 705; 95%CI：1. 205-27. 007;P=0. 028）, the number of prescribed antibiotics （OR3. 173; 95%CI： 1. 472-6. 841;P= 0. 003） and APACHE Ⅱ≥ 16 （OR6. 390; 950/00 CI： 1. 191-34. 281; P = 0. 021）. CONCLUSIONS Mechanical ventilation, the number of prescribed antibiotics and APACHE Ⅱ ≥16 are independent risk factors for nosocomial pneumonia due to PDRPA. The results of this study demonstrate a rationale for the development of effective interventions to minimize the impact of PDRPA.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2009年第6期673-676,共4页
Chinese Journal of Nosocomiology
基金
广东省自然科技基金资助项目(A5000423)
关键词
铜绿假单胞菌
危险因素
医院感染
Pseudomonas aeruginosa
Risk factor
Nosocomial infection
