在接受严重下肢缺血治疗的患者中爆发多重耐药铜绿假单胞菌的后果。
The consequences of an outbreak of multidrug-resistant Pseudomonas aeruginosa among patients treated for critical leg ischemia.
作者信息
Söderström Maria, Vikatmaa Pirkka, Lepäntalo Mauri, Aho Pekka-Sakari, Kolho Elina, Ikonen Tuija
机构信息
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
出版信息
J Vasc Surg. 2009 Oct;50(4):806-12. doi: 10.1016/j.jvs.2009.05.063. Epub 2009 Aug 5.
OBJECTIVE
This retrospective matched case-control study evaluated the consequences of multidrug-resistant Pseudomonas aeruginosa (MDR Pa) in critical leg ischemia (CLI) patients treated with infrainguinal bypass surgery (IBS).
METHODS
An outbreak of MDR Pa occurred on our vascular surgical ward during a 13-month period. Bacteria cultures positive for MDR Pa were obtained from 129 patients, and 64 CLI patients treated with IBS formed the study group. A control group of 64 was retrospectively matched from MDR Pa-negative patients treated with IBS in the same unit according to sex, age, presence of diabetes, Fontaine class, graft material, and site of the distal anastomosis. The most frequent sites of initial positive MDR Pa culture were the incisional wound in 30 (47%) and ischemic ulcer in 23 (36%). Median time between the positive MDR Pa-culture and IBS was 14 days (range, 56 days pre-IBS to 246 days post-IBS). Graft patency, survival, leg salvage, and amputation-free survival were assessed.
RESULTS
One-year amputation-free survival (+/- standard error) was 52% +/- 6% in the MDR Pa group vs 75% +/- 5% in the control group (P = .02). Five-year amputation-free survival was 29% +/- 6% in the MDR Pa group and 32% +/- 6% in the control group (P = .144). For MDR Pa and control groups, the 1-year survival was 69% +/- 6% and 82% +/- 5% (P = .063), respectively, and 5-year survival was 36% +/- 6% and 36% +/- 6% (P = .302), respectively. For the MDR Pa and control groups, leg salvage was 79% +/- 5% and 92% +/- 4% at 1 year (P = .078) and 73% +/- 7% and 87% +/- 5% at 5 years (P = .126), respectively. The overall secondary patency rate at 1 year was 72% +/- 7% in the MDR Pa group vs 81% +/- 6% in the control group (P = .149). Local wound surgery was more frequent in MDR Pa patients than in controls (P = .002).
CONCLUSIONS
The MDR Pa outbreak was associated with a decreased short-term amputation-free survival after IBS for CLI in patients with positive MDR Pa culture. The potential risks of MDR Pa should be seriously considered whenever a positive culture is obtained in a vascular patient with CLI.
目的
本回顾性配对病例对照研究评估了多药耐药铜绿假单胞菌（MDR Pa）对接受股腘动脉搭桥手术（IBS）治疗的严重下肢缺血（CLI）患者的影响。
方法
在13个月期间，我们血管外科病房爆发了MDR Pa感染。从129例患者中获取了MDR Pa细菌培养阳性样本，其中64例接受IBS治疗的CLI患者组成研究组。根据性别、年龄、糖尿病情况、Fontaine分级、移植物材料和远端吻合部位，从同一科室接受IBS治疗的MDR Pa阴性患者中回顾性匹配出64例作为对照组。最初MDR Pa培养阳性最常见的部位是切口伤口30例（47%）和缺血性溃疡23例（36%）。MDR Pa培养阳性与IBS之间的中位时间为14天（范围，IBS前56天至IBS后246天）。评估了移植物通畅率、生存率、保肢率和无截肢生存率。
结果
MDR Pa组1年无截肢生存率（±标准误差）为52%±6%，对照组为75%±5%（P = 0.02）。MDR Pa组5年无截肢生存率为29%±6%，对照组为32%±6%（P = 0.144）。MDR Pa组和对照组的1年生存率分别为69%±6%和82%±5%（P = 0.063），5年生存率分别为36%±6%和36%±6%（P = 0.302）。MDR Pa组和对照组1年时的保肢率分别为79%±5%和92%±4%（P = 0.078），5年时分别为73%±7%和87%±5%（P = 0.126）。MDR Pa组1年时的总体二次通畅率为72%±7%，对照组为81%±6%（P = 0.149）。MDR Pa患者的局部伤口手术比对照组更频繁（P = 0.002）。
结论
MDR Pa感染爆发与MDR Pa培养阳性的CLI患者接受IBS治疗后的短期无截肢生存率降低有关。对于血管性CLI患者，一旦获得阳性培养结果，应认真考虑MDR Pa的潜在风险。
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