实施抗菌药物管理提高铜绿假单胞菌对碳青霉烯类药物的敏感性

Implementing antimicrobial management to improve susceptibility of Pseudomonas aeruginosa to carbapenems

摘要:

目的分析临床分离的铜绿假单胞菌（PA）对碳青霉烯类药物的敏感性，并观察抗菌药物分级管理制度对其敏感性的影响。方法收集2012年10月—2014年3月北京大学肿瘤医院临床分离的PA，应用单因素分析及logistic多因素回归分析方法研究PA对碳青霉烯类药物不敏感的危险因素；并分析严格执行抗菌药物分级管理制度（抗菌药物管理）前后PA对碳青霉烯类药物的敏感性。结果临床共分离125株PA，主要来源于食管癌（30例，24.0%）和结直肠癌患者（29例，23.2%）；主要来源标本为引流液及伤口分泌物（62株，49.6%）；主要来源科室为外科病房（86株，68.8%）。单因素分析显示PA对碳青霉烯类药物不敏感与来自外科系统、3个月内曾住院、碳青霉烯类药物暴露、住院时间＞4周有关。Logistic回归分析结果表明3项独立危险因素为：来自外科系统、碳青霉烯类药物暴露、住院时间＞4周。抗菌药物管理后PA对碳青霉烯类药物的敏感率为74.6%，高于管理前的53.4%（P=0.015）。结论来自外科系统、碳青霉烯类药物暴露、住院时间＞4周是PA对碳青霉烯类药物不敏感的独立危险因素；严格执行抗菌药物分级管理制度后PA对碳青霉烯类药物的敏感率提高。

Abstract:

ObjectiveTo analyze susceptibility of clinically isolated Pseudomonas aeruginosa (PA) to carbapenems, and observe the effect of classified management of antimicrobial agents on carbapenem susceptibility.MethodsPA isolated from Peking University Cancer Hospital between October 2012 and March 2014 were collected, univariate analysis and multivariate logistic regression analysis were adopted to study the risk factors for nonsusceptibility to carbapenems, susceptibility of PA to carbapenems before and after the implementation of classified management of antimicrobial agents was analyzed. ResultsA total of 125 strains of PA were isolated, mainly from patients with esophageal cancer (n=30, 24.0%) and colorectal cancer (n=29, 23.2%); the main specimens were drainage fluid and wound secretion (n=62, 49.6%); the main source departments were surgical wards (n=86, 68.8%). Univariate analysis showed that nonsusceptibility of PA to carbapenems was related to strains from surgical wards, hospitalization within 3 months, carbapenem exposure, and length of hospital stay>4 weeks. Logistic regression analysis showed that 3 independent risk factors were: strains from surgical wards, exposure to carbapenems, and length of hospital stay>4 weeks. Susceptibility of PA to carbapenems after implementation of antimicrobial management was 74.6%, which was higher than 53.4% before management (P=0.015). ConclusionStrains from surgical wards, carbapenem exposure, and length of hospital stay>4 weeks are independent risk factors for nosusceptibility of PA to carbapenems; susceptibility of PA to carbapenems is increased after strict implementation of antimicrobial classified management system.