Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: Risk factors and mortality
Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: Risk factors and mortality
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DOI：
10.1016/j.jcrc.2009.03.006
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发表时间：
2009-12-01
影响因子：
3.7
通讯作者：
Medeiros, Eduardo A. S.
中科院分区：
文献类型：
--
作者：
Furtado, Guilherme H. C.;Bergamasco, Maria D.;Medeiros, Eduardo A. S.
目的：本研究旨在评估内科-外科重症监护病房（ICU）耐亚胺培南铜绿假单胞菌（IRPA）感染相关的危险因素和归因死亡率。方法：在某大学附属医院780张床位的16张床位的内科-外科ICU进行回顾性病例对照研究。本研究纳入2003年1月1日至2004年12月31日收治的所有因IRPA引起医院感染的患者。结果：63例亚胺培南耐药铜绿假单胞菌在研究期间恢复。根据入院时间、年龄和危险时间将182名对照者与病例相匹配。泌尿道（34.9%）和呼吸道（22.2%）是IRPA分离的主要来源。在多因素分析中，曾在ICU住院（优势比3.54；95%可信区间[CI] 1.29-9.73; P = 0.03）是IRPA感染的唯一独立危险因素。病例患者的住院死亡率为49%(63 / 31)，而对照组患者的住院死亡率为33%(182 / 61)（优势比1.92;95% CI 1.07-3.44; P = 0.02）。因此，我们的归因死亡率为16% （95% CI, 9.74%-22.3%; P = 0.03）。结论：我们的研究表明，IRPA感染与以前的ICU住院时间密切相关，并且IRPA感染显著增加了危重患者的死亡率。(C) 2009爱思唯尔公司版权所有。
Objectives: The aim of this study was to evaluate the risk factors and attributable mortality associated with imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in a medical-surgical intensive care unit (ICU).Methods: A retrospective case-control study was carried out at a 16-bed medical-surgical ICU in a 780-bed, university-affiliated hospital. All patients admitted from January 1, 2003, to December 31, 2004, who had nosocomial infection caused by IRPA, were included in the study.Results: Imipenem-resistant P. aeruginosa was recovered from 63 patients during the study period. One hundred eighty-two controls were matched with cases by period of admission, age, and time at risk. Urinary tract (34.9%) and respiratory tract (22.2%) were the main sources of IRPA isolation. In multivariate analysis, a previous stay in the ICU (odds ratio, 3.54; 95% confidence interval [CI], 1.29-9.73; P = .03) was the only independent risk factor for IRPA infection. The in-hospital mortality rate among case patients was 49% (31 of 63) compared with 33% (61 of 182) for control patients (odds ratio, 1.92; 95% CI, 1.07-3.44; P = .02). Thus, we had an attributable mortality of 16% (95% CI, 9.74%-22.3%; P = .03).Conclusions: Our study suggests that IRPA infections are strongly related to previous ICU stay, and that IRPA infections significantly increase mortality in those critical patients. (C) 2009 Elsevier Inc. All rights reserved.