下呼吸道鲍曼不动杆菌感染患者对亚胺培南、美罗培南和头孢哌酮舒巴坦耐药的易感因素分析
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摘要
目的研究影响下呼吸道鲍曼不动杆菌(Acinetobacter baumannii,AB)感染患者对亚胺培南(Imipenem,IPM)、美罗培南(Meropenem,MEM)和头孢哌酮舒巴坦(Cefperazone-Sulbactam,SCF)耐药的易感因素。方法收集下呼吸道感染患者的痰标本,分离出鲍曼不动杆菌感染944株,其中931株进行了IPM药物敏感试验,712株进行了MEM药物敏感试验,887株进行了SCF药物敏感试验,根据药物敏感试验结果分为耐药组和非耐药组,比较其多重耐药鲍曼不动杆菌(multidrug-resistant Acinetobacter baumannii,MDRAB)的检出率,比较不同性别、是否侵入性操作、是否泌尿道插管、是否气管插管、是否气管切开、是否使用呼吸机、是否进行中心静脉插管、是否手术、是否入住外科、是否入住ICU、住院次数、感染前住院时间、感染季节等不同环境条件下的耐药性,并进行Logistic回归分析。结果耐药组IPM、MEM和SCF的MDRAB检出率远高于不耐药组,差异均有统计学意义(P<0.05)。无论在IPM组、MEM组还是SCF组,男性、有侵入性操作、有泌尿道插管、有气管插管、有气管切开、应用呼吸机、行中心静脉插管、行手术、入住外科、入住ICU者均较女性、无侵入性操作、无泌尿道插管、无气管插管、无气管切开、未使用呼吸机、未行中心静脉插管、未行手术、未入住外科、未入住ICU者耐药检出率高,差异有统计学意义(P<0.05)。Logistic回归显示:使用呼吸机是促进AB对3种药物耐药概率升高的共同院内感染防控因素(P<0.05);男性、入住ICU、感染前使用抗生素≥5d和冬春季均是增加AB对IPM和MEM 2种药物耐药概率的共同危险因素(P<0.05);入住外科和住院1次均是增加AB对IPM耐药的独立危险因素(P<0.05)。结论应针对各种抗生素耐药发生的高危人群、高发季节和高发时段设计院内感染防控措施,缩短使用抗生素时间,重视早期细菌学检测,提高入院早期送检率,有效控制细菌对抗生素耐药的发生和发展。
Objective To evaluate the risk factors of the antibiotic resistance of Imipenem(IPM), Meropenem(MEM)and Cefperazone-Sulbactam(SCF)among the Acinetobacter baumannii(AB)pneumonia.Methods A total of 944 specimens from lower respiratory tract with acinetobacter baumannii pneumonia were identified:931,712 and 887 were subjected to antimicrobial susceptibility testing in IPM,MPM and SCF,respectively.The difference in the rate of multidrug-resistant Acinetobacter baumannii(MDRAB)and the clinical characteristics between the dichotomized resistant group and non-resistant group in the three antimicrobial susceptibility testing were analyzed,respectively.Then we used Logistic regression analysis to evaluate the risk factors.Results The MDRAB rates of the resistant group were higher than the non-resistant group in the three antibacterial agents(P< 0.05). There were significant differences in sex,the use of invasive operation,urinary tract intubation,trachea cannula,tracheotomy,ventilator,central venous catheter,surgery,internal or surgical department,intensive care unit,times of hospitalization,hospital stays and season between the dichotomized resistant group and non-resistant group in IPM,MEM and SCF(P<0.05).Logistic regression analysis suggested that the use of ventilator before delivery could increase the risk of these three antibiotic-resistance(P<0.05).While AB-pneumonia patients in men,intensive care unit,the antibiotic-use-days≥5 dand Spring-Winter could be easily resistant to both IPM and MEM(P<0.05).And resistance to IPM may easily happened in surgical department and only one timehospitalization(P<0.05).Conclusion he prevention and control measures should be designed according to the high-risk population,the high-incidence season and the high-occurrence period of each kind of drug-sensitive drug resistance,so as to shorten the time of antibiotic use,attach importance to the daily bacterial detection,improve the early detection rate at admission,and effectively control the occurrence and development of bacterial resistance to antibiotics.
Objective To evaluate the risk factors of the antibiotic resistance of Imipenem(IPM), Meropenem(MEM)and Cefperazone-Sulbactam(SCF)among the Acinetobacter baumannii(AB)pneumonia.Methods A total of 944 specimens from lower respiratory tract with acinetobacter baumannii pneumonia were identified:931,712 and 887 were subjected to antimicrobial susceptibility testing in IPM,MPM and SCF,respectively.The difference in the rate of multidrug-resistant Acinetobacter baumannii(MDRAB)and the clinical characteristics between the dichotomized resistant group and non-resistant group in the three antimicrobial susceptibility testing were analyzed,respectively.Then we used Logistic regression analysis to evaluate the risk factors.Results The MDRAB rates of the resistant group were higher than the non-resistant group in the three antibacterial agents(P< 0.05). There were significant differences in sex,the use of invasive operation,urinary tract intubation,trachea cannula,tracheotomy,ventilator,central venous catheter,surgery,internal or surgical department,intensive care unit,times of hospitalization,hospital stays and season between the dichotomized resistant group and non-resistant group in IPM,MEM and SCF(P<0.05).Logistic regression analysis suggested that the use of ventilator before delivery could increase the risk of these three antibiotic-resistance(P<0.05).While AB-pneumonia patients in men,intensive care unit,the antibiotic-use-days≥5 dand Spring-Winter could be easily resistant to both IPM and MEM(P<0.05).And resistance to IPM may easily happened in surgical department and only one timehospitalization(P<0.05).Conclusion he prevention and control measures should be designed according to the high-risk population,the high-incidence season and the high-occurrence period of each kind of drug-sensitive drug resistance,so as to shorten the time of antibiotic use,attach importance to the daily bacterial detection,improve the early detection rate at admission,and effectively control the occurrence and development of bacterial resistance to antibiotics.
引文
[1]李继红,时东彦,袁胡,等.2253株鲍曼不动杆菌耐药监测及临床价值评估[J].河北医科大学学报,2017,38(12):1439-1442,1447.
[2]Liu F,Wen Z,Wei J,et al.Epidemiology,microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China:a retrospective study[J].J Thorac Dis,2017,9(10):3875-3887.
[3]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[4]胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[5]Tajeddin E,Rashidan M,Razaghi M,et al.The role of the intensive care unit environment and health-care workers in the transmission of bacteria associated with hospital acquired infections[J].J Infect Public Health,2016,9(1):13-23.
[6]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(8):76-85.
[7]陈闽,江柳涛,蔡柏蔷.解读2011年成人下呼吸道感染的诊治指南(概述)[J].国际呼吸杂志,2012,32(16):1201-1206.
[8]American Thoracic Society,Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcareassociated pneumonia[J].Am J Respir Crit Care Med,2005,171(4):388-416.
[9]谭俊青,李蔼文,王康椿,等.头孢哌酮-舒巴坦联合中药对泛耐药鲍曼不动杆菌抗菌活性的研究[J].检验医学,2016,31(5):350-354.
[10]刘燕琳,宋传杰,尹玲,等.美罗培南联合头孢哌酮舒巴坦对3种多重耐药革兰阴性杆菌的抗菌活性研究[J].中国药房,2017,28(21):2912-2915.
[11]Huang H,Chen B,Liu G,et al.A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii[J].BMC Infect Dis,2018,18(1):11.
[12]侯芳,吕媛.不容忽视的细菌耐药[J].中国抗生素杂志,2017,42(3):203-206.
[13]陈亚男,刘菁,田丽梅,等.ICU多重耐药茵目标性监测与干预效果分析[J].中国感染控制杂,2017,16(1):58-65.
[14]郭建华,王春城,唐宇菲.胆结石患者术后医院感染的危险因素分析[J].河北医科大学学报,2015,36(2):152-155.
[15]Fukuta Y,Clarke LG,Shields RK,et al.Lack of Seasonality in the Occurrence of Multidrug-Resistant Acinectobacter baumannii Complex[J].Infect Control Hosp Epidemiol,2012,33(10):1051-1052.
[16]柳鹏程,苏犁云,曹凌峰,等.2011至2014年上海单中心下呼吸道感染住院患儿常见病原体流行病学研究[J].中国循证儿科杂志,2015,10(6):449-453.
[2]Liu F,Wen Z,Wei J,et al.Epidemiology,microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China:a retrospective study[J].J Thorac Dis,2017,9(10):3875-3887.
[3]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[4]胡付品.2005-2014年CHINET中国细菌耐药性监测网5种重要临床分离菌的耐药性变迁[J].中国感染与化疗杂志,2017,17(1):93-99.
[5]Tajeddin E,Rashidan M,Razaghi M,et al.The role of the intensive care unit environment and health-care workers in the transmission of bacteria associated with hospital acquired infections[J].J Infect Public Health,2016,9(1):13-23.
[6]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(8):76-85.
[7]陈闽,江柳涛,蔡柏蔷.解读2011年成人下呼吸道感染的诊治指南(概述)[J].国际呼吸杂志,2012,32(16):1201-1206.
[8]American Thoracic Society,Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcareassociated pneumonia[J].Am J Respir Crit Care Med,2005,171(4):388-416.
[9]谭俊青,李蔼文,王康椿,等.头孢哌酮-舒巴坦联合中药对泛耐药鲍曼不动杆菌抗菌活性的研究[J].检验医学,2016,31(5):350-354.
[10]刘燕琳,宋传杰,尹玲,等.美罗培南联合头孢哌酮舒巴坦对3种多重耐药革兰阴性杆菌的抗菌活性研究[J].中国药房,2017,28(21):2912-2915.
[11]Huang H,Chen B,Liu G,et al.A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii[J].BMC Infect Dis,2018,18(1):11.
[12]侯芳,吕媛.不容忽视的细菌耐药[J].中国抗生素杂志,2017,42(3):203-206.
[13]陈亚男,刘菁,田丽梅,等.ICU多重耐药茵目标性监测与干预效果分析[J].中国感染控制杂,2017,16(1):58-65.
[14]郭建华,王春城,唐宇菲.胆结石患者术后医院感染的危险因素分析[J].河北医科大学学报,2015,36(2):152-155.
[15]Fukuta Y,Clarke LG,Shields RK,et al.Lack of Seasonality in the Occurrence of Multidrug-Resistant Acinectobacter baumannii Complex[J].Infect Control Hosp Epidemiol,2012,33(10):1051-1052.
[16]柳鹏程,苏犁云,曹凌峰,等.2011至2014年上海单中心下呼吸道感染住院患儿常见病原体流行病学研究[J].中国循证儿科杂志,2015,10(6):449-453.