肿瘤患者鲍氏不动杆菌医院感染的临床分析

Tumor patients with nosocomial infections caused by acinetobacter baumannii:a clinical analysis

目的探讨肿瘤患者鲍氏不动杆菌医院感染的临床特点。方法收集医院2004年1月-2010年6月,诊治的83例肿瘤患者鲍氏不动杆菌医院感染的临床资料,对其临床表现、实验室检查结果、基础疾病、菌株来源及药敏结果、肿瘤治疗及抗菌药物应用、侵入性操作、疾病的转归等进行系统分析。结果 83例肿瘤患者中以中老年患者为主,58例占69.9%;合并基础疾病113例;贫血占86.0%,肺部感染占75.9%,多部位感染占15.7%;痰液分离率76.6%,检出菌株89株,以非发酵革兰阴性杆菌为主;对检出的鲍氏不动杆菌耐药率较低的药物为阿米卡星,其耐药率20.9%,亚胺培南、头孢吡肟、头孢他啶的耐药率分别为75.5%、83.5%和84.5%;鲍氏不动杆菌检查前15 d均采用了联合抗菌治疗,4种抗菌药物联合应用占47.0%,5种抗菌药物联合应用占27.7%;平均住院时间46 d,死亡45例。结论中老年晚期肿瘤患者易发生鲍氏不动杆菌的医院感染,以肺部感染为主,耐药性严重,预后差,应给予重视。

OBJECTIVE To investigate the clinical features of tumor patients with nosocomial infections caused by Acinetobacter baumannii （ABA）. METHODS A total of 83 cases with nosocomial infections caused by ABA from Jan 2004 to Jun 2010 were collected, and the systematic analysis of disease outcome based on their clinical data, including their clinical manifestations, laboratory findings, underlying diseases, sources of strain and susceptibility, tumor treatment and application of antibacterial drugs, invasive procedures and hospitalization time, was performed. RESULTS Of the 83 cases, there were 58 cases （69.9%） who were elderly patients; there were 113 cases of combined diseases. Pulmonary infection accounted for 75.9%, multi-site infections accounted for 15.7% ; anemia accounted for 86.0%. The isolation rate of sputum was 76.6% （89 strains detected from sputum, which were mainly non-fermenting Gram-negative bacilli）. Multidrug-resistant ABA was resistant to 17 kinds of antimicrobiaI agents, the resistance rates of ABA to amikaein, imipenem, eefepime and eeftazidime were 20.9%, 75. 5%, 83. 5% and 84. 5%, respectively; The combined antibiotic therapy were applied for 15 days before ABA examination, 4 kinds of antibiotics combined accounted 47. 0%, 5 kinds of antibiotics combined accounted for 27.7%; the average hospital stay was 46 days, 45 cases resulted in death. CONCLUSION It should attach great importance to the elderly patients with advanced tumors, who are prone to catch nosocomial infections caused by ABA and are mainly the pulmonary infection with serious drug resistance and poor prognosis.