ICU耐碳青霉烯类抗菌药物鲍曼不动杆菌肺部感染危险因素分析

Analysis of Risk Factors for Lung Infection of CRAb in ICU

目的:探讨重症监护室(ICU)耐碳青霉烯类抗菌药物鲍曼不动杆菌(CRAb)肺部感染的危险因素。方法:采用回顾性研究方法,收集宝鸡市中心医院ICU 2012年6月-2014年6月鲍曼不动杆菌(Ab)肺部感染患者105例,其中CRAb组患者81例,对碳青霉烯类抗菌药物敏感Ab(CSAb)组患者24例,对发生CRAb肺部感染的危险因素采用单因素分析及多因素Logistic多元回归分析。结果:单因素分析发现,分离出Ab前ICU住院天数、ICU总住院天数、呼吸衰竭、低蛋白血症、机械通气、机械通气天数、分离出Ab前15 d内碳青霉烯类抗菌药物的使用及联合应用抗菌药物、C反应蛋白检测异常、降钙素原检测异常与ICU CRAb肺部感染的发生显著相关;多因素分析显示,分离出Ab前ICU住院天数、分离出Ab前15 d内使用碳青霉烯类抗菌药物、分离出Ab前行机械通气、分离出Ab前患者低蛋白血症为Ab感染的独立危险因素。结论:入住ICU的高危患者,应结合危险因素,尽早采取措施,合理防治CRAb肺部感染。

OBJECTIVE：To discuss the risk factors for lung infection of CRAb in ICU,and to provide reference for clinical diagnosis and treatment. METHODS：The univariate analysis and multivariate Logistic regression analysis were conducted with the method of case-control study,in which the clinical data of 105 cases of lung infection of CRAb in ICU were collected from our hospital during Jun. 2012 to Jun. 2014,with the 81 cases of CRAb and 24 cases of CSAb. RESULTS：The univariate analysis showed that those factors were significantly correlated with lung infection of CRAb in ICU,such as ICU hospitalization days before isolation of Ab,total stay in ICU,respiratory failure,hypoproteinemia,mechanical ventilation,mechanical ventilation days,the application of carbapenem antimicrobial agents and combined use of antimicrobial agents within 15 days before isolation of Ab,abnormal C-reactive protein detection,abnormal procalcitonin detection. The multivariate analysis showed that ICU hospitalization days before isolation of Ab,the application of carbapenem antimicrobial agents within 15 days before isolation of Ab,mechanical ventilation,hypoproteinemia were the independent risk factors of CRAb. CONCLUSIONS：Based on risk factors,the measures should be taken for high-risk patients as soon as possible in ICU to prevent and treat lung infection of CRAb.