RICU医院获得性鲍曼不动杆菌肺炎49例临床分析

Hospital-acquired pneumonia due to acinetobacter baumannii in RICU-a report of 49 cases

目的:了解我院呼吸科重症监护病房(Respiratory intensive care unit,RICU)医院获得性鲍曼不动杆菌肺炎(Acinetobacter baumannii hospital-acquired pneumonia,ABHAP)的发病情况、耐药性特点以及危险因素,探讨预防和治疗ABHAP的措施。方法:收集我院RICU在2007年5月至2008年10月期间发生的医院获得性肺炎(Hospital-acquired pneumonia,HAP)患者的临床资料以及药敏试验结果,回顾性分析ABHAP的发病情况、耐药性特点以及相关危险因素。结果:共发生HAP159例,其中ABHAP49例,占全部HAP的30.8%,鲍曼不动杆菌是HAP的第二位常见病原菌,对常用三代头孢菌素和三代氟喹诺酮类抗菌药物耐药率均大于90%,对亚胺培南的耐药率为42.7%,全耐药率为23.5%。单因素分析发现:APACHEII评分≥20、RICU内住院时间≥2周、有创机械通气、有创机械通气≥7 d、气管插管或气管切开、气管插管或气管切开≥7d以及使用广谱抗生素≥7 d与发生ABHAP有关。多因素Lgistic回归分析确立了4项独立危险因素:RICU内住院时间≥2周(OR=5.334)、有创机械通气时间≥7 d(OR=7.561)、APACHEII评分≥20分(OR=2.962),以及使用广谱抗生素≥7 d(OR=3.509)。结论:RICU内ABHAP发生率高,耐药性强,治疗困难;缩短ICU住院时间,缩短有创机械通气时间,合理使用抗生素有利于预防和治疗ABHAP。

Objective： To investigate the prevalence, antibiotic resistance and risk factors of Acinetobacter Baumannii hospital-acquired pneumonia （ABHAP） in Respiratory Intensive Care Unit （RICU） of our hospital for guidance of clinical prevention and treatment of ABHAP. Methods： Clinical information and results of Antibiotic susceptibility test for all of the patients with hospital-acquired pneumonia （HAP） in RICU of our hospital from May 2007 to October 2008 were collected. Antibiotic resistance and risk factors of ABHAP were analyzed retrospectively. Results： 159 patients suffered from HAP. Of which, 49 patients had ABHAP and accounted for 30.8% of all cases. Acinetobacter Baumannii was the second commonest pathogen of HAP. The resistance rate of Acinetobacter Baumannii strains to the third generation of Cephalosporin and Fluoroquinolone were over 90%. And the resistance rate to Imipenen was 42.7%. Pan-resistant rate was 23.5%. Univariate analysis showed that APACHEII score ≥20, hospitalization in RICU ≥2 weeks, invasive mechanical ventilation, invasive mechanical ventilation ≥7 days, trachea intubation or tracheotomy, trachea intubation or tracheotomy ≥7 days and broad-spectrum antibiotic therapy ≥7 days were associated with BAHAP. Multivariate logistic analysis showed that hospitalization in RICU ≥ 2 weeks, invasive mechanical ventilation≥7 days, APACHEII score ≥20 and broad-spectrum antibiotic therapy ≥7 days were independent risk factors of ABHAP. Conclusions ： The present study found high incidence rate, severe drug-resistance and therapeutic difficulties of ABHAP in RICU. Shortening duration of hospitalization and invasive mechanical ventilation, rational use of antibiotics are helpful to prevent and treat ABHAP.