摘要
目的探讨重症监护病房(ICU)鲍曼不动杆菌感染的耐药性及相关危险因素,为临床合理用药和院内感染管理提供依据。方法选取2011年1月至2014年9月海南医学院附属医院ICU鲍曼不动杆菌感染患者284例和未感染鲍曼不动杆菌者284例,进行病例对照研究。分析院内感染鲍曼不动杆菌的耐药性,并通过多元Logistic回归分析发现独立危险因素。结果 ICU患者鲍曼不动杆菌感染以痰标本检出率最高为76.1%。单因素分析结果显示,昏迷GCS<8分、住ICU时间>7 d、机械通气时间>7 d、低白蛋白水平<25 g/L、气管插管、气管切开、使用抗菌药物>2种、混合细菌感染、肺基础疾病是危险因素。进一步应用多元Logistic回归分析发现,昏迷GCS<8分、机械通气时间>7 d、低白蛋白水平<25 g/L、气管插管、气管切开、使用抗菌药物>2种、混合细菌感染是鲍曼不动杆菌院内感染的独立危险因素。其危险性(OR)及P值分别为混合细菌感染(OR=3.621,P=0.004)、气管插管(OR=3.218,P=0.020)、使用抗菌药物>2种(OR=3.216,P=0.022)、机械通气时间>7 d(OR=3.046,P=0.018)、低白蛋白水平<25 g/L(OR=3.024,P=0.006)、气管切开(OR=3.014,P=0.038)、昏迷GCS<8分(OR=2.965,P=0.014)。鲍曼不动杆菌对哌拉西林、头孢曲松、头孢噻肟、头孢吡肟、阿米卡星、复方新诺明的耐药率均较高,其耐药率均在80.0%以上;对亚胺培南的耐药率相对较低,其耐药率为52.1%。结论鲍曼不动杆菌是ICU内检出率很高的条件致病菌,早期干预危险因素及合理使用抗菌药物,有助于减少ICU内鲍曼不动杆菌感染的发生率。
Objective To investigate the drug resistance and its related risk factors of Acinetobacter baumannii（A.baumannii）isolated from intensive care unit（ICU）in order to provide evidence for clinical rational drug use and nosocomialinfection management. Methods A case control study was carried out on 284 cases with A. baumannii infection and 284 cases without the bacterial infection who admitted in the ICU of the hospital between January 2011 and September 2014. Thedrug resistances of obtained stains were analyzed,and the independent risk factors were found by multivariate Logisticregression analysis. Results The highest detection rate was found in the sputum samples（76.1%）from the ICU patients withA. baumannii infection. Univariate analysis showed that Glasgow coma scale（GCS）score 〈8,ICU stay time 〉7 d,mechanicalventilation for over 7 d,albumin level 〈25 g/L,tracheal intubation,tracheotomy,use of 〉2 antimicrobial agents,mixed bacterialinfections,and primary pulmonary diseases were risk factors for the infection（P〈0.05）. Further multivariate logistic regressionanalysis indicated that GCS score 〈8（OR=2.965,P=0.014）,mechanical ventilation for over 7 d（OR=3.046,P=0.018）,albumin level 〈25 g/L（OR=3.024,P=0.006）,tracheal intubation（OR=3.218,P=0.020）,tracheotomy（OR=3.014,P=0.038）,use of 〉2 antimicrobial agents（OR=3.216,P=0.022）,and mixed bacterial infection（OR=3.621,P=0.004）were independentrisk factors for nosocomial infections of A. baumannii（all P〈0.05）. The resistant rates of the obtain bacterial strains were allabove 80.0% to piperacillin,ceftriaxone,cefotaxime,cefepime,amikacin and cotrimoxazole. But the rate to imipenem wascomparatively low,only 52.1%. Conclusion A baumannii is a conditional pathogenic bacterium with high detection rate inICU. Early intervention for the risk factors and rational use of antibiotics will help reduce the incidence of its infection in ICU.
作者
黄燕妮
胡海岩
羊文芳
苏显都
HUANG Yan-ni HU Hai-yan YANG Wen-fang SU Xian-du(The Faculty of Laboratory Medicine and Tropical Medicine, Hainan Medical College, Haikou, Hainan 571199, China)
出处
《中国热带医学》
CAS
2016年第9期925-929,共5页
China Tropical Medicine
关键词
鲍曼不动杆菌
耐药性
危险因素
Acinetobacter baumannii
Drug resistance
Risk factors
