| Background:Pseudomonas aeruginosa(PA)is the most common non-fermentative gram-negative bacterium in clinical practice.It is widely distributed in nature,especially in humid environments.It can be used as a normal flora to colonize the skin,respiratory tract,intestinal tract and ear canal of the human body.However,when the body's immune defense function is degraded,dysbacteriosis,and normal bacterial colonization are transferred,Pseudomonas aeruginosa transforms into opportunistic pathogens causing respiratory tract infections,endocarditis,urinary tract infections,central nervous system infections,bone and joint infections,eye infections,skin and soft tissue infections,digestive tract infections and even sepsis,etc.of various degrees of acute and chronic opportunistic infections.Therefore,it is a common pathogen that hospitals get sexually infected.According to CHINET's Bacterial Resistance Surveillance Network in China and the latest bacterial resistance monitoring data reported by various regions,Pseudomonas aeruginosa has a high detection rate in clinical practice,and its resistance to antimicrobial agents,especially carbapenems was a significant increase,and the proportion of multidrug-resistant or pan-resistant Pseudomonas aeruginosa strains gradually increased.At the same time,Pseudomonas aeruginosa has natural resistance to various drugs,is easy to produce complex resistance,and can be transmitted through various means such as contact,which has become a major difficulty in clinical treatment.The prevalence of Pseudomonas aeruginosa has obvious spatial and temporal differences.There is currently a lack of clinical studies on Pseudomonas aeruginosa infections in Shandong Province in recent years.Objective:Through studying the clinical features and drug sensitivity results of patients with Pseudomonas aeruginosa infection,we will further understand the latest epidemic situation of Pseudomonas aeruginosa in Shandong Province,drug resistance changes,and infection-related risk factors.To instruct doctors to use antimicrobial drugs properly,improve the prognosis of patients,and formulate appropriate infection prevention and control strategies.Method:The clinical data of 668 patients with Pseudomonas aeruginosa infections from July 2013 to July 2017 in Shandong University Qilu Hospital were collected for retrospective analysis.Results:1.Clinical distribution:Of 668 patients infected with Pseudomonas aeruginosa,461 were male(69%)and 207 were female(31%).The age ranges from 8 minutes after birth to 98 years,65 children(9.7%),32 young children(4.8%),97 young people(14.5%),136 people(20.4%)in the middle age,and 338 elderly people(50.6%).There were 251 cases from the ICU,86 cases from the respiratory department,79 cases from the health department,and 50 cases from the neonate.Pseudomonas aeruginosa culture positive samples were mainly derived from 500 cases of sputum,50 cases of soft tissue secretions,40 cases of urine,and 23 cases of digestive or abdominal secretions or drainage.The detection rate of carbapenem-resistant Pseudomonas aeruginosa was 46.3%between 2013 and 2017,and the detection rate of multi-drug-resistant P.aeruginosa was 36.4%.Mucinous Pseudomonas aeruginosa had 46 strains(6.89%),and 10 strains(21.70%)showed multidrug resistance.There were 622(93.11%)non-mucinous Pseudomonas aeruginosa strains,of which 233(37.50%)were multi-drug resistant.The multi-drug resistance of Pseudomonas aeruginosa with two different colony morphology had a statistically significant difference(P=0.032<0.05).2.Changes in resistance to Pseudomonas aeruginosa:(1)The resistance rates of amikacin,tobramycin,gentamicin,levofloxacin,and ciprofloxacin showed a decreasing trend overall;the resistance rate to cefepime varied from 27.3%to 35.9%.The resistance rate of piperacillin-tazobactam fluctuates between 38.3%and 45.9%,and the resistance rate to cefoperazone-sulbactam fluctuates between 31.9%and 43.6%.The resistance rates to ceftazidime,imipenem,meropenem and piperacillin are increasing.(2)During the period of 2016.7-2017.7 years,the resistance rate of PA to aminoglycosides,quinolones,cefepime,and cefoperazone-sulbactam was relatively low;carbapenem-susceptible Pseudomonas aeruginosa(CSPA)showed a low resistance rate(<30%)to most of the antibiotics tested(except for aztreonam).(3)The resistance rate of CRPA isolates to most antimicrobial agents(except polymyxin B)was significantly higher than that of CSPA isolates(P<0.05).3.Risk factors:From the 2015-2017 cases,305 cases were randomly selected for analysis.Univariate analysis showed that:within 90 days of admission to the ICU(P=0.006),invasive ventilation(P = 0.022),arterial and central venous catheterization(P = 0.000),and nasogastric tube or naso-intestinal tube(P = 0.031)and diabetes(P = 0.011)were risk factors for CRPA infection.Multivariate logistic regression analysis showed that the underlying disease of diabetes(P=0.028,OR=2.096,95%CI:1.082?4.06)was an independent risk factor for CRPA infection.4.Treatment:During the anti-infective treatment of 305 patients,228 cases(94.43%)were treated with empirically applied antibacterial drugs,and 138(60.53%)of them were empirically treated drugs as sensitive antibiotics in the drug sensitivity test.Among the 77 cases with unexperienced antibacterial therapy and 90 cases with inappropriate empirical treatment,88 cases were adjusted according to drug sensitivity results.5.Prognosis:Of the 305 patients infected with Pseudomonas aeruginosa,250 were improved and discharged,28 failed and discharged automatically,27 died,and the mortality rate was 8.85%.Patients with CRPA infection have a higher risk of death than CSPA-infected patients(P=0.045).Conclusion:1.Pseudomonas aeruginosa infections are mainly among middle-aged and older men.Preterm infants with bronchopulmonary dysplasia and respiratory distress syndrome are also susceptible populations and need attention.2.Patients with Pseudomonas aeruginosa infections are widely distributed in more than 30 clinical departments in our hospital.Number of patients in the intensive care unit,respiratory department,health care department,and neonatology tops the list,and the detection rate of carbapenem-resistant Pseudomonas aeruginosa and multidrug resistant Pseudomonas aeruginosa in these departments is higher.Hospitals should actively control and prevent bacterial infections in these departments,avoid cross-infection and iatrogenic infection.3.The sites of infection with Pseudomonas aeruginosa are mostly respiratory tract,skin and soft tissue,abdominal cavity,digestive tract and urinary tract.4.The antibiotic sensitivity test in vitro showed that the multi-resistance rate of non-mucinous Pseudomonas aeruginosa was higher than that of mucinous Pseudomonas aeruginosa.5.The resistance rates of Pseudomonas aeruginosa to amikacin,tobramycin,genta micin,levofloxacin and ciprofloxacin have been decreasing in the past 4 years.The r esistance rates to cefepime,piperacillin-tazobactam,cefoperazone-sulbactam did not cha nge significantly.The resistance rates to ceftazidime,imipenem,meropenem,and pipera cillin showed an overall upward trend.CRPA has higher resistance to almost all anti-PA antibacterial drugs(except polymyxin)than CSPA,has stronger drug resistance,an d most of them have multidrug resistance.Empirical treatment of Pseudomonas aerugi nosa infections can use drugs with high sensitivity such as ciprofloxacin,cefoperazone-sulbactam,levofloxacin,gentamici,tobramycin,amikacin,cefepime,polymyxin.Howeve r,there is still a need to fully assess the patient's basic physiological conditions,seve rity of illness and the risk of infection with multidrug-resistant bacteria or carbapenem-resistant bacteria.If the associated risks are low,carbapenem antibiotics may be used for empirical treatment.6.Within 90 days of admission to the ICU,invasive ventilation,arterial and central venous catheter,nasogastric tube or naso-intestinal tube(P=0.031)were risk factors for CRPA,and diabetes was an independent risk factor.The risk of contracting CRPA in patients with diabetes is 2.096 times than that without diabetes.7.The mortality rate of patients infected with Pseudomonas aeruginosa in our hospital was 8.85%.Compared with CSPA-infected patients,CRPA-infected patients have an increased risk of death. |
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