重症监护室铜绿假单孢菌肺炎患者预后和无效经验性治疗的风险因素分析

李园园; 葛卫红<sup>*</sup>; 于锋

引用本文:	李园园,葛卫红,于锋.重症监护室铜绿假单孢菌肺炎患者预后和无效经验性治疗的风险因素分析[J].中国现代应用药学,2014,31(3):364-369.
	LI Yuanyuan,GE Weihong,YU Feng.Risk Factors of Clinical Outcomes and Inadequate Initial Antibiotic Therapy with Pneumonia Caused by Pseudomonas Aeruginosa in Intensive Care Unit[J].Chin J Mod Appl Pharm(中国现代应用药学),2014,31(3):364-369.

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重症监护室铜绿假单孢菌肺炎患者预后和无效经验性治疗的风险因素分析
李园园^1,2, 葛卫红¹, 于锋²
1.南京大学医学院附属南京市鼓楼医院药剂科，南京 210008;2.中国药科大学临床药学教研室，南京 210009

摘要:

目的研究重症监护室(ICU)的铜绿假单孢菌(PA)肺炎的死亡率及风险因素，分析影响无效经验性治疗(IIAT)的因素。方法回顾性分析2009年1月—2013年3月ICU的101例PA肺炎患者的临床信息，Logistic回归分析死亡和IIAT的相关危险因素。结果细菌培养111株PA中有45.0%为多药耐药PA(MDRPA)；101例患者中37例患者接受IIAT治疗，37例患者死亡。Logistic回归分析显示，影响PA肺炎死亡的独立因素有住院天数、CPIS评分、APACHEⅡ评分和IIAT。MDRPA是IIAT的独立风险因素(OR，34.5；95% CI，9.8~112.0；P<0.001)。结论 IIAT是影响ICU PA肺炎死亡率的主要独立风险因素，MDRPA是IIAT 的独立风险因素。

关键词: 铜绿假单胞菌肺炎重症监护室多药耐药无效经验性治疗

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Risk Factors of Clinical Outcomes and Inadequate Initial Antibiotic Therapy with Pneumonia Caused by Pseudomonas Aeruginosa in Intensive Care Unit

LI Yuanyuan^1,2, GE Weihong¹, YU Feng²

1.Pharmacy Department of Nanjng Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China;2.Clinical Pharmacy of China Pharmaceutical University, Nanjing 210009, China

Abstract:

OBJECTIVE To identify the mortality and risk factor of intensive care unit(ICU) patients with Pseudomonas aeruginosa (PA) pneumonia and the factors related with inadequate initial antibiotic therapy(IIAT). METHODS A retrospective analysis of 101 ICU patients with PA pneumonia from Jan, 2009 to Mar, 2013 was conducted. Logistic regression analysis was used to identify the risk factors of mortality and IIAT. RESULTS The 45.0% of isolated PA was multidrug resistance PA(MDRPA). There were 37 cases of 101 patients received IIAT. Logistic regression analysis identified the independent risk factors that associated with mortality were hospital days, CPIS, APACHEⅡ and IIAT. Only MDRPA was the predictive factor of IIAT (OR, 34.5; 95% CI, 9.8-112.0; P<0.001). CONCLUSION Our findings highlight the importance of IIAT as a risk factor for mortality in ICU patients with PA pneumonia. The independent risk factor of IIAT is MDRPA.

Key words: Pseudomonas aeruginosa pneumonia intensive care unit multidrug resistance inadequate initial antibiotic therapy