儿科重症监护病房鲍曼不动杆菌感染的危险因素与耐药性分析

Risk factors and drug resistance of Acinetobacter baumannii infection in pediatric intensive care unit

目的了解儿童重症监护病房(PICU)鲍曼不动杆菌感染的危险因素及耐药情况。方法总结2006年1月至2011年9月PICU中99例鲍曼不动杆菌感染患儿的资料,对鲍曼不动杆菌感染的发生率、发生时间及感染部位进行分析,了解PICU鲍曼不动杆菌感染的危险因素及耐药情况。结果 PICU共收治危重患儿4 762例,鲍曼不动杆菌感染患儿99例,发生率为2.08%(99/4762),死亡14例,病死率14.14%(14/99)。发生鲍曼不动杆菌的时间为入PICU后(12.4±9.3)d。主要为肺部感染93例(93.94%);伤口感染4例(4.04%);尿路感染2例(2.02%)。发生鲍曼不动杆菌感染的危险因素为长期使用广谱抗生素、儿童危重病例评分低、机械通气及留置导尿管。近三年(2009—2011年)耐药水平比前三年(2006—2008年)有明显上升趋势。结论鲍曼不动杆菌易引起院内感染,主要为肺部感染,且耐药性明显上升。应加强抗生素的合理应用、加强病区的管理和侵入性操作时的无菌管理。

Objective To analyze risk factors and drug resistance of Acinetobacter baumannii infection in Pediatric intensive care unit （PICU）. Methods The data of patients with Acinetobacter baumannii infection in our PICU from Jan 2006 to Sep 2011 were retrospectively summarized. The incidence of A cinetobacter baumannii infection, and infection time and location were analyzed. The risk factors and drug resistance of Acinetobacter baumannii in fection in PICU were studied. Results There were 4 762 patients in PICU during 6 years, among whom 99 patients were infected with Acinetobacter baumannii, so the incidence of Acinetobacter baumannii infections was 2.08% （99/4762）. Among them, 40 patients died and the morbidity was 14.14% （14/99）. The infection occurred at 12.4 ± 9.3 d after admission to PICU. The infection location was lung infection in 93 cases （93.94%）, wound infection in 4 cases （4.04%）, and urinary tract infection in 2 cases （2.02%）. Risk factors of A cinetobacter baumannii infection included long-term use of broad-spectrum antibiotic, lower pediatric critical illness Score, mechanical ventilation, urinary drainage tube. The rates of drug resistance was raised in past 3 years （2009 -- 2011） compared with previous 3 years. Conclusions Acine- tobacter baumannii easily to cause nosocomial infection, mainly lung infection, with higher drug resistance. Rational use of antibiotics, enhancement of ward management, and operation of sterile invasive management should be strengthened.