【摘要】 目的探讨碳青霉烯类抗生素暴露对老年重症肺炎多重耐药菌(MDRO)检出率及预后的影响。方法回顾性调查2014年2月—2016年2月某院重症医学科收治的老年重症肺炎患者。根据是否存在碳青霉烯类抗生素暴露分为A组(碳青霉烯暴露组)、B组(非碳青霉烯暴露组)。A组患者再依据碳青霉烯类抗生素暴露时间分为2个亚组,A1组:应用碳青霉烯类抗生素时间>7 d的患者;A2组:应用碳青霉烯类抗生素时间≤7 d的患者。对各组患者MDRO检出率、机械通气日数、入住ICU日数及28 d病死率进行比较分析。结果共纳入患者86例,其中男性57例,女性29例;年龄65~92岁,平均年龄(80.12±10.45)岁。A组40例,B组46例;A1组24例,A2组16例。A组MDRO检出率为65.00%,B组为36.96%,差异有统计学意义(P<0.05);两组患者比较,A组的机械通气日数、入住ICU日数、28 d病死率均高于B组,差异均具有统计学意义(均P<0.05)。A1组的MDRO检出率为75.00%,高于A2组的43.75%(P<0.05);A1组的机械通气日数为(7.69±2.22)d,高于A2组的(6.34±1.56)d(P<0.05);A1、A2组28 d病死率及入住ICU日数比较,差异均无统计学意义(均P>0.05)。结论碳青霉烯类抗生素暴露可增加MDRO感染的发生,特别是非发酵菌的定植或感染,且延长了患者机械通气日数及入住ICU日数,影响患者预后。更多还原

【Abstract】 Objective To evaluate the effect of carbapenem exposure on isolation rate of multidrug-resistant organisms(MDROs)and prognosis of elderly patients with severe pneumonia.Methods Elderly patients with severe pneumonia and admitted to the intensive care unit in a hospital between February 2014 and February 2016 were investigated retrospectively.According to whether there was carbapenem exposure,patients were divided into group A(carbapenem exposure group)and group B(carbapenem non-exposure group).Patients in group A were subdivided into two subgroups according to exposure time of carbapenems,group A1 received carbapenems for>7 days,group A2 received carbapenems for≤7 days.The isolation rates of MDROs,mechanical ventilation days,length of stay in ICU,and 28-day mortality among groups were compared and analyzed.Results A total of 86 patients were enrolled in the investigation,57 were males and 29 were females;the average age was(80.12+10.45)years(range:65-92 years).There were 40 cases in group A,46 in group B;24 cases in group A1,and16 in group A2.The isolation rates of MDROs in group A and group B were 65.00% and 36.96% respectively,difference was statistically significant(P<0.05);Comparison between two groups of patients revealed that mechanical ventilation days,length of stay in ICU,and 28-day mortality in group A were all higher than group B,difference was statistically significant(all P<0.05);the isolation rates of MDROs in group A1 was higher than group A2(75.00% vs43.75%,P<0.05);mechanical ventilation days of group A1 was higher than group A2([7.69±2.22]d vs[6.34±1.56]d,P<0.05);28-day mortality and length of stay in ICU between group A1 and A2 were not significantly different(both P>0.05).Conclusion Carbapenem exposure can increase the occurrence of MDRO infection,especially the non-fermentative bacterial colonization or infection,and prolong the mechanical ventilation days and length of stay in ICU,thus affect the prognosis of patients.更多还原