鲍曼不动杆菌血流感染预后危险因素分析

Risk factors for fatality 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及菌株耐药情况.方法 回顾性分析2011年1月至2014年5月天津医科大学总医院80例血流感染鲍曼不动杆菌住院患者的资料,包括年龄、性别、入住科室、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.采用多因素Logistic回归分析影响预后的相关因素.结果 80株鲍曼不动杆菌对头孢他啶、头孢曲松,头孢西丁的耐药率高达90％以上,对亚胺培南的耐药率为66.3％,对头孢哌酮/舒巴坦以及替加环素的耐药率较低,分别为7.5％和2.5％.入住ICU[优势比（OR）=6.67,95％可信区间（95％ CI）为2.01 ～ 22.07,P＜0.01],多重耐药（OR=3.55,95％ CI为1.30～9.69,P＜0.05）,APACHEⅡ评分≥19（OR=39.00,95％ CI为9.87 ～ 154.09,P＜0.01）,动脉插管（OR=3.24,95％ CI为1.16～9.04,P＜0.05）,中央静脉插管（OR=3.33,95％ CI为1.22 ～9.12,P＜0.05）,气管插管（OR=3.60,95％ CI为1.31 ～9.88,P＜0.05）,气管切开（OR =3.21,95％ CI为1.19 ～8.66,P＜0.05）,其他有创操作（OR =3.00,95％ CI为1.11～ 8.08,P＜0.05）为鲍曼不动杆菌血流感染患者死亡的危险因素.结论 侵入性操作与细菌的耐药性会增加鲍曼不动杆菌血流感染患者的病死率.

Objective To investigate the antibiotic resistance of Acinetobacter baumannii,and to identify the risk factors for fatality of Acinetobacter baumannii bloodstream infection.Methods A retrospective review was conducted on 80 patients with Acinetobacter baumannii bloodstream infections admitted in Tianjin General Hospital during January 2011 to May 2014.Clinical data including demographic information,the ward of stay,underlying diseases,treatment,invasive procedures,antibiotic resistance,acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score at admission were collected.Multivariate Logistic regression analysis was performed to identify the risk factors for fatality.Results There were ≥90％ strains resistant to ceftazidime,ceftriaxone and cefoxitin,and 66.3％ strains were resistant to imipenem.While most strains were sensitive to cefoperazone/shubatan and tigecycline,and the resistance rates were 7.5％ and 2.5％,respectively.ICU admission （OR =6.67,95％ CI：2.01-22.07,P ＜0.01）,multi-drug resistance （OR =3.55,95％ CI：1.30-9.69,P ＜ 0.05）,APACHE Ⅱ score ≥ 19 （OR =39.00,95％ CI：9.87-154.09,P ＜ 0.01）,artery catheterization （OR =3.24,95％ CI：1.16-9.04,P ＜ 0.05）,central venous catheterization （OR =3.33,95％ CI：1.22-9.12,P ＜ 0.05）,tracheal catheterization （OR=3.60,95％CI：1.31-9.88,P＜0.05）,tracheostomy （OR=3.21,95％CI：1.19-8.66,P＜0.05）,and other invasive procedures （OR =3.00,95％ CI：1.11-8.08,P ＜ 0.05） were the risk factors for fatality.Conclusion Invasive procedures and multi-drug resistance are associated with increased fatality of patients with Acinetobacter baumannii bloodstream infection.