Barron Michelle A, Richardson Kris, Jeffres Meghan, McCollister Bruce
Division of Infectious Diseases, University of Colorado Denver, 12700 E. 19th Ave, B168, Aurora, CO 80045 USA.
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado Denver, Mail Stop C 238, 12850 E. Montview Blvd, V20-1212, Aurora, CO 80045 USA.
Springerplus. 2016 Jun 17;5(1):755. doi: 10.1186/s40064-016-2438-4. eCollection 2016.
Patients with Pseudomonas aeruginosa infections from blood or sterile sites were evaluated to determine risk factors associated with carbapenem resistance (CRPA) compared to carbapenem sensitivity (CSPA) as well as prior carbapenem use and the development of resistance.
Retrospective chart review of 80 patients hospitalized with a documented P. aeruginosa infection during 2010-2011. Stored isolates were retested with both Kirby-Bauer disk diffusion and E-tests. Clinical characteristic of patients in the CRPA (N = 21) and the CSPA (N = 59) groups were similar. Hospital acquired (HA) infections were more common in the CRPA group compared to the CSPA group (71 vs 44 %, p = 0.04) and CRPA patients were more likely to have a Foley catheter at the time of infection (71 vs 37 %, p = 0.01). There was more carbapenem use in the CRPA group prior to onset of infection (59 vs 22 %, OR 5.1, 95 % CI 1.3-20.8, p = 0.01). Length of stay was significantly longer in the CRPA group (mean 44 days) compared to the CSPA group (mean 23 days), p = 0.02. Mortality between the two groups was similar and there were no differences between groups for death attributable to Pseudomonas.
Patients with CRPA were more likely to have HA infections and to have a multidrug resistant profile. Other identifiable risks included a Foley catheter in place at the time of infection and exposure to a carbapenem prior to infection. Prompt removal of devices and judicious use of antibiotics may be interventions that can impact the development of this kind of infections.
对血液或无菌部位感染铜绿假单胞菌的患者进行评估，以确定与碳青霉烯耐药（CRPA）相关的危险因素，并与碳青霉烯敏感（CSPA）进行比较，同时评估先前碳青霉烯的使用情况及耐药性的发展。
对2010 - 2011年期间80例有记录的铜绿假单胞菌感染住院患者进行回顾性病历审查。储存的分离株采用 Kirby - Bauer 纸片扩散法和 E 试验重新检测。CRPA组（N = 21）和CSPA组（N = 59）患者的临床特征相似。与CSPA组相比，CRPA组医院获得性（HA）感染更为常见（71% 对44%，p = 0.04），且CRPA患者在感染时更可能留置导尿管（71% 对37%，p = 0.01）。CRPA组在感染发作前使用碳青霉烯的情况更多（59% 对22%，OR 5.1，95% CI 1.3 - 20.8，p = 0.01）。CRPA组的住院时间明显长于CSPA组（平均44天）（平均23天），p = 0.02。两组之间的死亡率相似，且因铜绿假单胞菌导致的死亡在组间无差异。
CRPA患者更可能发生HA感染且具有多重耐药特征。其他可识别的风险包括感染时留置导尿管以及感染前接触碳青霉烯。及时移除设备和明智使用抗生素可能是影响这类感染发生的干预措施。
