鲍曼不动杆菌血流感染预后的危险因素分析

Analysis of risk factors on prognosis of Acinetobacter baumannii bloodstream infection

目的 探讨影响鲍曼不动杆菌血流感染预后的危险因素.方法 回顾性分析2010年1月至2012年1 1月南京医科大学第一附属医院住院的78例鲍曼不动杆菌血流感染患者的病例资料.根据28 d预后分为死亡组（40例）和存活组（38例）,收集人口学资料、入住单元、基础疾病、治疗、有创操作、细菌耐药性和入院时急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分；通过多因素logistic回归分析确定独立危险因素,采用受试者工作特征曲线（ROC曲线）下面积比较预测价值.结果 入住ICU[优势比（OR）=12.9,95％可信区间（95％CI）为2.4 ～ 63.5,P=0.001]、气道开放（包括气管插管和气管切开,OR=6.2,95％CI为1.5 ～30.4,P=0.023）、有创机械通气（OR=5.1,95％CI为1.4 ～ 22.6,P=0.042）、除深静脉置管的其他有创操作（包括胸腔穿刺、骨髓穿刺、腰椎穿刺、留置尿管、纤维支气管镜肺泡灌洗、动静脉内瘘成形术,OR=8.4,95％CI为1.7～37.8,P=0.011）、入院时APACHEⅡ≥19分（OR=35.4,95％CI为3.8 ～ 318.6,P=0.001）是鲍曼不动杆菌血流感染患者死亡的危险因素.以APACHEⅡ≥19分为分界点,ROC曲线下面积为0.938（P＜0.05）,敏感度为76.2％,特异度为94.1％.细菌的耐药性对预后无明显影响.结论 侵入性操作及治疗会增加危重症鲍曼不动杆菌血流感染患者的病死率；APACHEⅡ≥19分提示鲍曼不动杆菌血流感染预后差.

Objective To explore the risk factors on prognosis of Acinetobacter baumannii bloodstream infection.Methods Clinical data from 78 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Nanjing Medical University from January 2010 to November 2012 were analyzed retrospectively.According to the 28-day prognosis after admission,the patients were divided into non-survivors （n=40） and survivors （n=38）.Data on demographic and clinical characteristics,wards,underlying diseases,treatments,invasive medical procedures,bacterial resistance to antibiotics,and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score in the beginning were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.The predictor value was concluded by comparing area under the receiver operating characteristic curve （ROC curve） of each index.Results Risk factors of mortality of Acinetobacter baumannii bloodstream infection goes as following,including intensive care unit admission [ICU,odds ratio （OR）=12.9,95％ confidence interval （95％ CI） 2.4-63.5,P=0.001],trachea intubationor tracheostomy （OR =6.2,95％ CI 1.5-30.4,P=0.023）,invasive mechanical ventilation （OR =5.1,95％ CI 1.4-22.6,P=0.042）,invasive medical procedure besides central venous catheter （including thoracentesis,bone marrow puncture,lumbar puncture,catheterization,bronchoalveolar lavage with bronchofibroscope,arteriovenous fistula plastic operation,OR =8.4,95％CI 1.7-37.8,P=0.011）,APACHE Ⅱ score ≥ 19 in the beginning （OR=35.4,95％CI 3.8-318.6,P=0.001）.With respect to APACHE Ⅱ score ≥ 19 as mortality cut-off point,an area under the receiver operating curve of 0.938 was statistically significant （P＜0.05）,with sensitivity 76.2％ and specificity 94.1％.The relationship between prognosis and antibiotic resistance did not have statistically significance.Conclusion Invasive medical procedures and treatments were associated with increased mortality of patients with Acinetobacter baumannii bloodstream infection.A strong predictor of adverse outcome in such conditions was APACHE Ⅱ score ≥ 19.