| Background:Pseudomonas aeruginosa is representative of pseudomonas strains, and widely exist inhospital environment. Pseudomonas aeruginosa is often founded in hands of medical personnel, air of wards, medical equipments, especially the oxygen tubes, humidifier, endotracheal intubation, ventilator. Pseudomonas aeruginosa belongs to the human pathogens. Pseudomonas aeruginosa isolated from community infection often founded in chronic bronchitis, bronchiecta sis,lung cysts. Pseudomonas aeruginosa is more common in hospital infection. Pseudomonas aeruginosa is one of main pathogenic bacteria, and Pseudomonas aeruginosa of 18.3% is the second proportion in gram-negative bacilli. Patients with lower immune function and the old are easy to infect it. With the application of bronchoscopy, trachea intubation, mechanical ventilator, nosocomial pneumonia due to Pseudomonas aeruginosa is high morbidity.Currently the main antimicrobial agents for Pseudomonas aeruginosa are ceftazidime, cefepime, cefoperazone/sulbactam, piperacillin/tazobactam, Aztreonam, levoflozacin, ciprofloxacin, amikacin, imipenem, meropenem. Pseudomonas aeruginosa occurs resistance with complex mechanism, due to its structure and the result antimicrobial induced. The resistance status of Pseudomonas aeruginosa becomes more and more serious, along with the wide application of antimicrobial agents. The nosocomial pneumonia due to Pseudomonas aeruginosa is with high mortality.Now the main antibiotic therapy for Pseudomonas aeruginosa pneumonia is effective antibiotic therapy and alternate pulse therapy. The precise etiology and results of antibiotic susceptibility test are very important for directing treatment. So we need fing factors to evalue treatment effect and prognosis.Objective:1. To explore the drug resistance status of Pseudomonas aeruginosa.2. To investigate the risk factors related with mortality for nosocomial pneumonia due to Pseudomonas aeruginosa.Methods:1. The date of 136 cases of Pseudomonas aeruginosa septicemia from Jan 2006 to May 2009 in Nanfang Hospital were collected.2. The date of the included cases were studied retrospectively. The clinical characteristics of initial nosocomial pneumonia due to Pseudomonas aeruginosa, including:time of intial culture, age, gender, hospital department, duration of hospital stay before nosocomial pneumonia, length of hospitalization, stay-in-ICU, comorbid illness, invasive procedure, immunosuppressive therapy, laboratory findings, results of initial culture, antibiotic treatments during the 15 days prior to nosocomial pneumonia, and outcome were recorded.3. Pseudomonas aeruginosa from cultures in patients was isolated by PHOEN IX 100 automation system. Antibiotic susceptibility test was performed by K-B disk diffusion method. Pseudomonas aeruginosa was confirmed by using standard of National Commitee for Clinical Laboratory Standards into sensitive, resistant, and intermediate.4. Prognostic index:the mortality.5. All the data were analyzed by SPSS software 13.0 version. The drug resistance status of Pseudomonas aeruginosa was analyzed withχ2 test(Pearson Chi-Square or Fisher's Exact Test). The prognostic factors of univariate analysis:The measurement data was analyzed with t test(equal variances assumed), or Satterthwaite estimation t test(equal variances not assumed). The enumeration data was analyzed withχ2 test(Pearson Chi-Square or Fisher's Exact Test). On the basis of univariate analysis, the variables P＜0.05 were analyzed with binary Logistic regression analysis, identifing the independent risk factors of mortality for nosocomial pneumonia due to Pseudomonas aeruginosa. P<0.05 is a statistically significant difference.Results:1.136 patients with nosocomial pneumonia due to Pseudomonas aeruginosa were included in this retrospective study.90patients were male, and 46 patients were female.43 patients were in neurosurgery ward,39 patients were in division of respiratory disease,19 patients were in nephrology department,14 patients were in surgical ICU,21 patients were in other wards.2. The resistant rates of Pseudomonas aeruginosa strains to 10 common usable antibiotics:cefoperazone/sulbactam has the lowest resistant rate 15.48%, followed by ciprofloxacin 27.66%. The resistant rates to Meropenem, ceftazidime, cefepime, amikacin, levoflozacin, piperacillin/tazobactam, imipenem, were 32.65%,37.12%, 38.21%,38.28%,40.69%,40.94%,44.53% respectively. Aztreonam has the highest resistant rate 46.32%. The multidrug resistance rate of Pseudomonas aeruginosa strains was 27.2%, and pan-drug resistance rate of Pseudomonas aeruginosa strains was 8.1%.3. The resistant rates of meropenem-resistant Pseudomonas aeruginosa strains or imipenem-resistant Pseudomonas aeruginosa strains to common usable antibiotics were more than that of the sensitive strains, while remarkable differences (P<0.05). So were to MDR-Pseudomonas aeruginosa and PDR-Pseudomonas aeruginosa.4. The resistant rates of Pseudomonas aeruginosa strains isolated from ICU to ceftazidime, cefepime, piperacillin/tazobactam, Aztreonam, amikacin, imipenem, were more than that from non-ICU, while remarkable differences (P<0.05). But no differences were to cefoperazone/sulbactam, ciprofloxacin, levoflozacin, meropenem, P>0.05. The multidrug resistance rate of Pseudomonas aeruginosa strains isolated from ICU were more than that from non-ICU, while remarkable differences (P<0.05). But no differences were for pan-drug resistance rate of Pseudomonas aeruginosa strains.5.115 patients survived, and 21 patienst died. The mortality was 15.4%.6. The univariate analysis results:the factors associated with the higher mortality were CPIS(t=-5.581,P=0.000), lower CPIS at day 5(χ2=30.818,P=0.000), immunosuppressive therapy(P=0.008), mechanical ventilation(χ2=6.295,P=0.012), comorbid respiratory failure(χ2=7.948,P=0.005), comorbid diabetes(P=0.043), MDR-Pseudomonas aeruginosa(χ2=11.239,P=0.001), PDR-Pseudomonas aeruginosa(P=0.002), appropriate empiric antibiotic therapy(χ2=12.521,P=0.000), the differences were statistically significant, P＜0.05.7. Empiric monotherapy with lower CPIS at day 5 of 50.0%, empiric combination antibiotic therapy with lower CPIS at day 5 of 68.8%, the difference of proportion was statistically significant,χ2=4.270,P=0.039. Appropriate empiric antibiotic therapy with lower CPIS at day 5 of 73.0%, inappropriate empiric antibiotic therapy with lower CPIS at day 5 of 51.6%, the difference of proportion was statistically significant,χ2=6.621,P=0.010.8. Binary Logistic regression analysis identified two independent risk factors of mortality:CPIS(P=0.000, OR=5.010) and Pan-drug resistance Pseudomonas aeruginosa(P=0.029, OR=15.300). Lower CPIS at day 5 is a protective factor.Conclusions:1. The highest morbidity of nosocomial pneumonia due to Pseudomonas aeruginosa was in neurosurgery ward.2. Cefoperazone/sulbactam has the lowest resistant rate. Aztreonam has the highest resistant rate.3. The resistant rates of imipenem-resistant Pseudomonas aeruginosa strains or meropenem-resistant Pseudomonas aeruginosa strains to common usable antibiotics were more than that of the sensitive strains. So were to multidrug resistance and pan-drug resistance strains.4. The resistant rates of Pseudomonas aeruginosa strains isolated from ICU to ceftazidime, cefepime, piperacillin/tazobactam, Aztreonam, amikacin, imipenem, and multidrug resistance rate were more than that from non-ICU.5. The CPIS, lower CPIS at day 5, immunosuppressive therapy, mechanical ventilation, comorbid respiratory failure, comorbid diabetes, MDR-Pseudomonas aeruginosa, PDR-Pseudomonas aeruginosa, appropriate empiric antibiotic therapy were associated with the mortality of nosocomial pneumonia due to Pseudomonas aeruginosa.6. Appropriate empiric antibiotic therapy and empiric combination antibiotic therapy can increase the frequency of lower CPIS at day 5. 7. CPIS and Pan-drug resistance Pseudomonas aeruginosa were independent mortality risk factors for nosocomial pneumonia due to Pseudomonas aeruginosa. Lower CPIS at day 5 is a protective factor.
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