脓毒症患者中多重耐药鲍曼不动杆菌感染危险因素分析

Analysis of risk factors of multi-drug resistant acinetobacter baumannii infection in patients with sepsis

目的 探讨综合重症监护病房（ICU）多重耐药（multi-drug resistant,MDR）鲍曼不动杆菌（Acinetobacter baumannii,Ab）感染脓毒症患者的临床特征和危险因素.方法 回顾分析2009年7月至2013年3月我院综合ICU入住脓毒症患者856例,通过比较多重耐药Ab感染脓毒症患者179例（病例组）与非多重耐药Ab感染脓毒症患者677例（对照组）的临床资料,探讨两组患者的病死率、住院费用、器官功能损害情况和死亡的危险因素.结果 多重耐药Ab感染脓毒症患者病死率、48 h病死率及住院费用较对照组高（P＜0.05）;多重耐药Ab感染脓毒症患者较对照组更易发生感染性休克、急性肾损伤和骨髓抑制;多重耐药Ab感染脓毒症患者如果APECHEⅡ评分＞25分、24 h内出现多脏器功能障碍综合征（MODS）、感染性休克,则其死亡风险更高（P＜0.05）.结论 多重耐药Ab感染脓毒症患者具有病死率高、治疗费用昂贵等特征,及时发现患者的死亡危险因素并进行针对性干预极其重要.

Objective To investigate the clinical characteristics and risk factors of multi-drug resistant （MDR） acinetobacter baumannii （Ab） infection in patients with sepsis in ICU.Methods Retrospectively analyzed clinical data of 856 cases of sepsis admitted in ICU of our hospital from July 2009 to March 2013,who were divided into MDR Ab related sepsis group （179 cases） and non-MDR Ab related sepsis group （control group,677 cases）.Mortality rate,hospitalization expenses,organ function injury level and risk factors of death were compared between two groups.Results Mortality rate,48 hours mortality rate and hospitalization cost of MDR Ab related sepsis group were higher than those of control group （P ＜ 0.05）.Septic shock,acute kidney injury and bone marrow suppression more likely occurred in MDR Ab related sepsis group （P ＜ 0.05）.APACHE Ⅱ score ＞ 25,septic shock and multiple organ dysfunction syndrome （MODS） within 24 h were risk factors of death in MDR Ab related sepsis group （P ＜ 0.05）.Conclusions Patients with MDR Ab related sepsis have worse prognosis and spend more in related treatment.It is important to detect risk factors of death and implement targeting treatment early.