Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
PLoS One. 2018 Feb 22;13(2):e0193431. doi: 10.1371/journal.pone.0193431. eCollection 2018.
The incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.
We retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014.
Of the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant Pseudomonas aeruginosa (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05-36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36-10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44-7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66-28.82), admission to a medical department (aOR 4.67; 95% CI 1.81-12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50-9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05-7.08).
The prevalence of XDR-PA infections represented almost a quarter of Pseudomonas aeruginosa hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.
广泛耐药铜绿假单胞菌（XDR-PA）引起的医院感染发病率在全球范围内呈上升趋势。我们调查了 XDR-PA 感染的流行情况和相关因素，包括预测死亡率的因素。
我们回顾性研究了 2014 年 4 月至 12 月期间住院的铜绿假单胞菌（PA）感染成年患者队列。
在 255 例 PA 感染患者中，56 例（22%）为 XDR-PA，32 例（12.5%）为多药耐药铜绿假单胞菌（MDR-PA），167 例（65.5%）为非 MDR-PA。接受全胃肠外营养（调整后的比值比 [aOR] 6.21；95%可信区间 1.05-36.70）、碳青霉烯类药物使用史（aOR 4.88；95%可信区间 2.36-10.08）和氟喹诺酮类药物使用史（aOR 3.38；95%可信区间 1.44-7.97）与 XDR-PA 感染独立相关。所有 XDR-PA 对黏菌素仍保持敏感。感染相关死亡率的相关因素包括脓毒症/感染性休克（aOR 11.60；95%可信区间 4.66-28.82）、内科住院（aOR 4.67；95%可信区间 1.81-12.06）、中央静脉导管（aOR 3.78；95%可信区间 1.50-9.57）和 XDR-PA 感染（aOR 2.73；95%可信区间 1.05-7.08）。
XDR-PA 感染的流行率占医院获得性铜绿假单胞菌感染的近四分之一，死亡率更高。当怀疑 XDR-PA 感染时，应及时给予适当的经验性抗生素治疗。
