Gasink Leanne B, Fishman Neil O, Nachamkin Irving, Bilker Warren B, Lautenbach Ebbing
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Infect Control Hosp Epidemiol. 2007 Oct;28(10):1175-80. doi: 10.1086/520740. Epub 2007 Aug 3.
To identify risk factors for infection or colonization with aztreonam-resistant Pseudomonas aeruginosa and examine the impact of this organism on mortality.
A case-control study was performed to identify risk factors for infection or colonization with aztreonam-resistant P. aeruginosa. A cohort study was subsequently performed to examine the impact of aztreonam resistance on outcomes.
A tertiary referral center in southeastern Pennsylvania.Participants. Inpatients with a clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.
Of 720 P. aeruginosa. isolates, 183 (25.4%) were aztreonam-resistant and 537 (74.6%) were aztreonam susceptible. In a multivariable model, prior fluoroquinolone use (adjusted odds ratio [aOR], 1.81 [95% confidence interval {CI}, 1.17-2.80]), prior use of an antianaerobic agent (aOR, 1.56 [95% CI, 1.06-2.29]), and renal insufficiency (aOR, 1.59 [95% CI, 1.10-2.29]) were associated with infection or colonization with aztreonam-resistant P. aeruginosa, while older age (aOR, 0.98 [95% CI, 0.97-0.99] per year of age) was negatively associated with infection or colonization with this organism. In-hospital mortality was higher among subjects infected or colonized with aztreonam-resistant P. aeruginosa, compared with those who were infected or colonized with aztreonam-susceptible P. aeruginosa (25.7% vs 16.8%; P=.009), but in multivariable analysis, no significant association was found between infection or colonization with aztreonam-resistant P. aeruginosa and mortality.
Curbing the use of fluoroquinolones and antimicrobials with antianaerobic activity may be an effective strategy to limit the emergence of aztreonam-resistant P. aeruginosa.
确定耐氨曲南铜绿假单胞菌感染或定植的危险因素，并研究该菌对死亡率的影响。
进行一项病例对照研究以确定耐氨曲南铜绿假单胞菌感染或定植的危险因素。随后进行一项队列研究以检验氨曲南耐药对结局的影响。
宾夕法尼亚州东南部的一家三级转诊中心。
1999年1月1日至2000年12月31日期间临床培养出铜绿假单胞菌阳性的住院患者。
在720株铜绿假单胞菌分离株中，183株（25.4%）对氨曲南耐药，537株（74.6%）对氨曲南敏感。在多变量模型中，既往使用氟喹诺酮类药物（校正比值比[aOR]，1.81[95%置信区间{CI}，1.17 - 2.80]）、既往使用抗厌氧菌药物（aOR，1.56[95%CI，1.06 - 2.29]）和肾功能不全（aOR，1.59[95%CI，1.10 - 2.29]）与耐氨曲南铜绿假单胞菌感染或定植相关，而年龄较大（每年年龄的aOR，0.98[95%CI，0.97 - 0.99]）与该菌感染或定植呈负相关。与氨曲南敏感铜绿假单胞菌感染或定植的患者相比，耐氨曲南铜绿假单胞菌感染或定植的患者院内死亡率更高（25.7%对16.8%；P = 0.009），但在多变量分析中，未发现耐氨曲南铜绿假单胞菌感染或定植与死亡率之间存在显著关联。
限制氟喹诺酮类药物和具有抗厌氧菌活性的抗菌药物的使用可能是限制耐氨曲南铜绿假单胞菌出现的有效策略。
