摘要
目的:探讨呼吸与危重症医学科碳青霉烯类耐药鲍曼不动杆菌(carbapenem resistant acinetobacter baumannii,CRAB)感染的临床特征以及对临床常用抗菌药物的耐药特性,以期为临床多重耐药细菌抗感染治疗提供理论依据。方法:回顾性收集2019年1月至2021年12月,在北京安贞医院呼吸与危重症医学科确诊为CRAB感染181例住院患者的病历资料,对其感染发生后的临床表现、合并症以及临床预后进行分析总结,根据临床标本分离的CRAB菌株体外药敏结果判断地区性耐药模式。结果:181例CRAB感染患者,总感染发生率为4.1%,65岁及以上老年人占比高达151例(83.4%)。慢性阻塞性肺疾病96例(53.0%)、支气管哮喘80例(44.2%)、支气管扩张症55例(30.4%)和肺部恶性肿瘤52例(28.7%)是需要患者住院治疗最常见的四类肺部基础疾病,同时大部分患者合并有高血压106例(58.6%)、糖尿病88例(48.6%)、心力衰竭50例(27.6%),既往或目前经历过心脏外科手术48例(26.5%)以及脑血管疾病43例(23.8%)和除肺部恶性肿瘤以外的其他实体器官肿瘤或血液系统肿瘤19例(10.5%)。临床标本最常来源于痰液128例(70.7%)和血液22例(12.2%)。体外药敏结果显示CRAB感染后对临床常用抗菌药物头孢吡肟(88.9%)和头孢他啶(85.1%)耐药率最高,其次是环丙沙星、头孢曲松、头孢唑林和左氧氟沙星,分别为65.7%、64.1%、62.4%、和56.4%,对替加环素和多黏菌素耐药率保持低度耐药,分别为6.1%和4.4%。研究期间,CRAB感染后住院患者全因死亡率为16.0%,与非碳青霉烯类耐药鲍曼不动杆菌感染住院患者全因死亡率(4.5%)等比较,差异有统计学意义(P=0.001);同时也发现,感染CRAB住院患者中位住院时间12d(7~18)d较非CRAB感染组患者7d(4~9)d明显延长,差异比较具有统计学意义(P=0.024)。结论:CRAB感染发生率高,并且对临床常用抗菌药物高度耐药,导致可供选择的抗菌药物治疗有限、住院期间病死率高,因此,早期识别耐药菌感染的高危人群,加强医院感染预防控制措施的实施,对降低耐药菌感染的发生率和病死率至关重要。
Objective:To investigate the clinical characteristics of carbapenem resistant Acinetobacter baumannii(CRAB)infection in respiratory and critical care medicine and its resistance to commonly used clinical antibiotics.In order to provide theoretical basis for clinical multi-drug resistant bacteria anti-infection treatment.Methods:The medical records of 181 hospitalized patients diagnosed with CRAB infection in the Department of Respiratory and Critical Care Medicine of Beijing Anzhen Hospital from January 2019 to December 2021 were retrospectively collected.The clinical manifestations,comorbidities and clinical prognosis after infection were analyzed and summarized,and the regional drug resistance mode was determined according to the in vitro drug sensitivity results of the CRAB strain isolated from clinical specimens.Results:Among 181 patients with CRAB infection,the total infection rate was 4.1%,and the elderly aged 65 and above accounted for 151 cases(83.4%).96 cases of chronic obstructive pulmonary disease(53.0%),80 cases of bronchial asthma(44.2%),55 cases of bronchiectasis(30.4%)and 52 cases of lung malignancy(28.7%)were the four most common types of underlying lung diseases requiring hospitalization.At the same time,most of the patients had hypertension in 106 cases(58.6%),mellitus diabetes in 88 cases(48.6%)and heart failure in 50 cases(27.6%).There were 48 patients(26.5%)who had undergone cardiac surgery,43 patients(23.8%)with cerebrovascular diseases and 19 patients(10.5%)with tumors of other solid organs or blood system other than lung malignancies.Clinical specimens were most often derived from sputum in 128 cases(70.7%)and blood in 22 cases(12.2%).In vitro drug sensitivity results showed that after CRAB infection,the drug resistance rate to commonly used clinical antibiotics cefepime(88.9%)and ceftazidme(85.1%)was the highest,followed by ciprofloxacin,ceftriaxone,cefzolin and levofloxacin,which were 65.7%,64.1%,62.4%and 56.4%,respectively.The resistance rate to tigecycline and polycolistin remained low,with 6.1%and 4.4%,respectively.During the study period,the all-cause mortality rate of hospitalized patients after CRAB infection was 16.0%,which was statistically significant compared with that of hospitalized patients infected with non-carbapenem resistant Acinetobacter baumannii(4.5%)(P=0.001).Meanwhile,the median hospital stay of patients with CRAB infection was 12 days(7-18 days),which was significantly longer than that of patients with non-CRAB infection(4-9 days),and the difference was statistically significant(P=0.024).Conclusions:CRAB has a high incidence of infection and is highly resistant to commonly used clinical antibiotics,which leads to limited antimicrobial treatment options and high fatality rate during hospitalization.Therefore,early identification of high-risk groups of drug-resistant bacterial infections and strengthening the implementation of nososoial infection prevention and control measures are crucial for reducing the incidence and fatality rate of drug-resistant bacterial infections.
作者
安春荣
任建伟
朱光发
AN Chunrong;REN Jianwei;ZHU Guangfa(Department of Respiratory and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2024年第1期35-40,共6页
Journal of Cardiovascular and Pulmonary Diseases
关键词
碳青霉烯耐药
鲍曼不动杆菌
感染
临床特征
耐药性
Carbapenem resistance
Acinetobacter baumannii
Infection
Clinical characteristics
Drug resistance
