Effect of carbapenem exposure on isolation rate of multidrug-resistant organisms and prognosis of elderly patients with severe pneumonia / 中国感染控制杂志

ABSTRACT

Objective To evaluate the effect of carbapenem exposure on isolation rate of multidrug resistant organisms(MDROs) and prognosis of elderly patients with severe pneumonia.Methods Elderly patients with severe pneumonia and admitted to the intensive care unit in a hospital between February 2014 and February 2016 were investigated retrospectively.According to whether there was carbapenem exposure,patients were divided into group A(carbapenem exposure group) and group B(carbapenem non exposure group).Patients in group A were subdivided into two subgroups according to exposure time of carbapenems,group A1 received carbapenems for＞7 days,group A2 received carbapenems for ≤7 days.The isolation rates of MDROs,mechanical ventilation days,length of stay in ICU,and 28 day mortality among groups were compared and analyzed.Results A total of 86 patients were enrolled in the investigation,57 were males and 29 were females;the average age was (80.12 + 10.45) years (range65-92 years).There were 40 cases in group A,46 in group B;24 cases in group A1,and 16 in group A2.The isolation rates of MDROs in group A and group B were 65.00％ and 36.96％ respectively,difference was sta tistically significant(P＜0.05);Comparison between two groups of patients revealed that mechanical ventilation days,length of stay in ICU,and 28 day mortality in group A were all higher than group B,difference was statistically significant(all P＜0.05);the isolation rates of MDROs in group A1 was higher than group A2 (75.00％ vs 43.75％,P＜0.05)；mechanical ventilation days of group A1 was higher than group A2 ([7.69 ± 2.22]d vs [6.34±-1.56]d,P＜0.05);28-day mortality and length of stay in ICU between group A1 and A2 were not significantly different(both P＞0.05).Conclusion Carbapenem exposure can increase the occurrence of MDRO infection,especially the non-fermentative bacterial colonization or infection,and prolong the mechanical ventilation days and length of stay in ICU,thus affect the prognosis of patients.