泛耐药鲍氏不动杆菌医院感染患者临床特点及预后分析

Clinical characteristics of patients with nosocomial infections caused by pandrug-resistant Acinetobacter baumannii and analysis of prognosis

目的：总结泛耐药鲍氏不动杆菌（PDRAB）医院感染患者的临床特点，分析其感染患者的预后危险因素，为临床治疗提供合理依据。方法回顾性总结2010年1月－2012年12月176例PDRAB医院感染患者临床资料，根据其预后分为存活组110例和死亡组66例，采用单因素分析及 logistic逐步回归法对感染患者的危险因素进行分析。结果176例 PDRAB医院感染患者死亡66例，病死率为37．5％；多发生于中心ICU占60．8％，其次为烧伤病区占22．7％；主要为下呼吸道感染占80．7％，其次为创面分泌物占10．9％，血液、静脉导管、泌尿道感染分别占4．5％、2．8％、1．1％；存活组与死亡组比较，年龄、基础疾病、机械通气、恶性肿瘤、总住院时间、ICU治疗时间和APACHEⅡ评分等7个危险因素，差异均有统计学意义（P＜0．05）；多因素 logistic回归分析后发现A‐PACHEⅡ评分（P＝0．000，OR值1．414，95％ CI 1．262-1．585）是死亡的独立危险因素（P＜0．01）。结论 PDRAB医院感染患者病死率较高，高龄、基础疾病多、IC U 住院时间长等多种危险因素对患者的预后产生不良影响，A‐PACHE Ⅱ评分是PDRAB感染患者预后危险因素的重要评估指标。

OBJECTIVE To observe the clinical characteristics of patients with nosocomial infections caused by pan‐drug‐resistant Acinetobacter baumannii （PDRAB） and analyze the risk factors for prognosis of the patients with infections so as to provide guidance for clinical treatment .METHODS The clinical data of 176 patients with PDRAB infections who were treated in the hospital from Jan 2010 to Dec 2012 were retrospectively analyzed ,then the par‐ticipants were divided into the survival group with 110 cases and the death group with 66 cases according to the prognosis ,and the univariate analysis and logistic regression analysis were performed for the risk factors for noso‐comial infections .RESULTS Of 176 patients with PDRAB infections ,66 cases died ,with the mortality rate of 37 .5% ,and 60 .8% of the infection cases distributed in the central ICU ,22 .7% in the burn ward ;the patients with lower respiratory tract infections accounted for 80 .7% ,the patients with wound secretions 10 .9% ,the pa‐tients with blood infections ,4 .5% ,the patients with venous catheter‐associated infections 2 .8% ,the patients with urinary tract infections 1 .1% .As compared with the seven risk factors ,including the age ,underlying dis‐ease ,mechanical ventilation ,malignant tumor ,total length of hospital stay ,length of ICU stay ,and APACHEⅡscore ,there was statistically significant difference between the survival group and the death group （P〈 0 .05） . The multivariate logistic regression analysis showed that the APACHE Ⅱ score（P= 0 .000 ,OR value= 1 .414 , 95% CI 1 .262‐1 .585） was the independent risk factor for death （P〈0 .01） .CONCLUSION The mortality rate of the patients with PDRAB infection is high .The risk factors such as the advanced age ,multiple underlying disea‐ses ,and long duration of ICU stay may adversely affect the prognosis of the patients ,and the APACHE Ⅱ score is an important indicator for evaluation of the risk factors for the prognosis .