综合ICU内鲍曼不动杆菌的耐药性和相关因素分析

Analysis of drug resistance of Acinetobacter baumannii and its related factors in ICU

目的 探讨综合重症监护病房（ICU）内鲍曼不动杆菌耐药性及相关危险因素,为院内多重耐药、泛耐药及全耐药鲍曼不动杆菌的防治提供临床依据.方法 采用回顾性分析方法,统计2011年1月至2013年6月入住广东省佛山市中医院ICU 1050例患者的病例资料,采用单因素方差分析,筛选出医院感染的危险因素；再将P＜0.05的危险因素进行非条件logistic多元回归分析,筛选出医院感染的独立危险因素,分析院内感染鲍曼不动杆菌的耐药性及其相关因素.结果 1050例ICU患者中有113例发生鲍曼不动杆菌院内感染,发生率为10.76％；其中96例为多重耐药、泛耐药及全耐药鲍曼不动杆菌,占84.96％.鲍曼不动杆菌在痰液中的检出率为79.65％,尿液中为10.62％,伤口分泌物中为4.42％,血液中为3.54％,其他引流液中为1.77％.单因素方差分析显示：机械通气、住ICU时间≥7 d、昏迷[格拉斯哥昏迷评分（GCS）＜8分]、使用广谱抗菌药物是鲍曼不动杆菌院内感染的危险因素（P＜0.05或P＜0.01）.多因素logistic回归分析显示：鲍曼不动杆菌院内感染的独立危险因素有机械通气[相对比值比（OF）=2.957,95％可信区间（95％ CI） 1.106～6.253,P=0.023]、住ICU时间≥7 d（OR=2.991, 95％CI 1.135 ～ 6.544,P=0.022）、昏迷（GCS＜8分,OR=2.894,95％ CI 1.803～ 7.462,P=0.010）、使用广谱抗菌药物（OR=3.054,95％CI 1.009～ 6.550,P=0.004）.鲍曼不动杆菌对多黏菌素B耐药率最低,为6.19％；其次为妥布霉素和替加环素,分别为11.50％和28.32％.结论 鲍曼不动杆菌是ICU内检出率很高的条件致病菌,检出部位主要在下呼吸道,与机械通气、住ICU时间、昏迷状态、使用广谱抗菌药物等因素相关,它对抗菌药物耐药率极高.应针对各种危险因素,采取综合措施包括环境隔离及严格床单位消毒,加强手卫生宣教和执行监督,尽量减少机械通气时间和ICU住院时间,加强痰液、分泌物等体液的引流,合理使用抗菌药物等方面,以减少ICU内鲍曼不动杆菌感染的发生率.

Objective To investigate drug resistance of Acinetobacter baumannii and its related factors in intensive care unit （ICU）,and to provide clinical basis for prevention and treatment.Methods A retrospective analysis was conducted.Clinical data was collected from 1 050 patients in ICU of Foshan Hospital of Traditional Chinese Medicine from January 2011 to June 2013.The risk factors of nosocomial infection were analyzed with univariate analysis.The independent risk factor was sieved from the risk factors with P＜0.05 with unconditional logistic regression analysis to analyze the related factors and drug resistance of Acinetobacter baumannii in ICU.Results One hundred and thirteen patients suffering from nosocomial infection of Acinetobacter baumannii were found,and its incidence rate was 10.76％.There were 96 cases of infection of multi-drug resistant,extensive-drug resistant and pan-drug resistant Acinetobacter baumannii,accounting for 84.96％.Acinetobacter baumannii detection rate was 79.65％ in sputum,10.62％ in urine,4.42％ in wound secretion,3.54％ in blood,and 1.77％ in other drainage discharges,respectively.Univariate analysis showed that mechanical ventilation,ICU stay time≥7 days,coma [Glasgow coma score （GCS）＜8],usage of broad-spectrum antibiotics were risk factors of nosocomial infection of Acinetobacter baumannii.Multivariate logistic analysis showed that the independent risk factors of nosocomial infection caused by Acinetobacter baumannii in ICU were mechanical ventilation [odds ratio （OR） =2.957,95％ confidence interval （95％ CI）1.106-6.253,P=0.023],ICU stay time≥7 days （OR=2.991,95％CI1.135-6.544,P=0.022）,coma （GCS＜8,OR=2.894,95％ CI 1.803-7.462,P=0.010）,and usage of broad-spectrum antibiotics （OR =3.054,95％ CI 1.009-6.550,P=0.004）.Rate of resistance to polymyxin B was the lowest （6.19％）,and it was followed by tobramycin and tigecycline,11.50％ and 28.32％,respectively.Conclusions Acinetobacter baumannii in ICU was conditional pathogenic bacteria with high infection rate,and the lower respiratory tract was the main site of infestation.The related factors include mechanical ventilation,ICU stay time,coma,usage of broad-spectrum antibiotics.Its antimicrobial resistance rate was high.Comprehensive measures,including environmental isolation,strict bed unit disinfection,enforcement of hand disinfection,strengthening the effort to shorten the duration of mechanical ventilation,reduction of ICU length of stay,enhancement of drainage of mucus,excretions,and other body fluids,and rational use of antibiotics should be encouraged in order to reduce Acinetobacter baumannii in ICU.