多重耐药鲍曼不动杆菌脓毒症高危因素及细菌耐药的相关性研究

Risk factors of acinetobacter baumannii infection and antibiotics treatment

目的 通过对多重耐药鲍曼不动杆菌脓毒症的高危因素及细菌耐药情况进行分析,指导临床抗生素使用,防止和减少多重耐药鲍曼不动杆菌脓毒症的发生.方法 采用回顾性病例对照研究,选择2009年至2013年我院PICU多重耐药鲍曼不动杆菌脓毒症患儿36例作为病例组,选择同期我院PICU非耐药鲍曼不动杆菌感染脓毒症患儿42例作为对照组,对不合理使用抗生素、住院时间、是否气管插管、机械通气时间、基础疾病（恶性血液病、先天性心脏病、遗传代谢病）、是否中心静脉置管及中心静脉置管时间7个高危因素进行比较,对多重耐药鲍曼不动杆菌进行药物敏感性分析.结果 病例组较对照组不合理使用抗生素（29例vs.18例）、住院时间＞7d（35例vs.12例）、气管插管（22例vs.8例）、机械通气时间＞7d（19例vs.2例）、患基础疾病（9例vs.3例）、中心静脉置管（18例vs.2例）及中心静脉置管时间＞7d（9例vs.1例）的病例数明显增加,差异有统计学意义（P＜0.05）;多重耐药鲍曼不动杆菌对青霉素类、头孢菌素类、氨基糖苷类、喹诺酮类、磺胺类药物具有较高的耐药率,分别为94.87％、74.36％、76.92％、65.38％、56.41％,而对碳氢霉烯类及四环素类仍保持较高的敏感率（分别为55.56％、77.78％）;泛耐药鲍曼不动杆菌（5类、6类抗生素耐药）感染16例（44.44％）;全耐药鲍曼不动杆菌（7类抗生素耐药）感染4例（11.11％）.结论 不合理使用抗生素、住院时间、是否气管插管、机械通气时间、基础疾病、是否中心静脉置管及长期中心静脉置管是发生多重耐药鲍曼不动杆菌脓毒症的高危因素;多重耐药鲍曼不动杆菌对临床一线抗生素耐药,仅对碳氢霉烯类及四环素类抗生素仍保持较高的敏感率,对四环素类的敏感率最高.

Objective To reduce the incidence rate of sepsis caused by multidrug-resistant acinetobacter baumanni and provide the basis for clinical antibiotics use.Methods It is one retrospective case-controled study.Thirty-six patients with multidrug-resistant acinetobacter baumanni infection（case group） and 42 patients with non-multidrug-resistant acinetobacter baumanni infection（control group） admitted in PICU during 2009 to 2013 were enrolled in the study.Seven high risk factors including the irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases （hematologic malignancies,congenital heart disease,inherited metabolic diseases）,use of central venous catheters and the length of using central venous catheters were analyzed.The drug sensitivity of multidrug resistant acinetobacter baumanni was detected.Results There were significantly differences in 7 high risk factors between case group and control group,including irrational antibiotics using （29 cases vs.18 cases）,the length of hospital stay 〉7 d（35 cases vs.12 cases）,tracheal intubation（22 cases vs.8 cases）,mechanical ventilation 〉 7 d （19 cases vs.2 cases）,basic diseases （9 cases vs.3 cases）,using of central venous catheters （18 cases vs.2 cases） and central venous catheters using 〉 7 d（9 cases vs.1 cases） ;multidrug resistant acinetobacter baumanni had high resistance against penicillins,cephalosporins,aminoglycesides,quinolones,sulfonamides （94.87%,74.36%,76.92%,65.38% and 56.41%）,but had high sensitivity to carbapenems and tetracyclines （55.56% and 77.78 %）.Sixteen cases infected with pandrug resistant acinetobacter baumanni infection （44.44%）,4 cases infected with whole drugresistant acinetobacter baumanni （11.11%）.Conclusion The irrational antibiotics use,the length of hospital stay,tracheal intubation,the length of mechanical ventilation,the basic diseases,central venous catheters and the length of using central venous catheters are the high risk factors of spesis caused by multidrug resistant acinetobacter baumanni; only carbapenems and tetracyclines can keep high sensitivity rate to multidrug resistant acinetobacter baumanni among clinical antibiotics.