耐碳青霉烯类鲍氏不动杆菌医院感染风险分析

Risk factors for nosocomial infections due to carbapenem-resistant Acinetobacter baumannii

目的识别耐碳青霉烯类鲍氏不动杆菌(CRAB)医院感染的风险关键控制点,为有效预防控制及治疗提供参考依据。方法采用病例对照研究,收集2014年5月-2015年5月CRAB医院感染患者37例以及碳青霉烯类敏感鲍氏不动杆菌(CSAB)医院感染患者30例的临床资料,构建非条件logistic回归模型分析,预测CRAB医院感染风险。结果 68株医院感染鲍氏不动杆菌中CRAB 38株占55.88%;CRAB感染的科室及感染部位分布均比较集中,ICU及神经外科在48.64%和43.24%,下呼吸道感染占71.05%;入住ICU(OR=26.244)和感染前使用碳青霉烯类抗菌药物(OR=9.488)与CRAB医院感染之间存在关联(P<0.05)。结论入住ICU和感染前使用碳青霉烯类抗菌药物是CRAB医院感染的独立危险因素,强化ICU医院感染预防控制措施,合理应用碳青霉烯类抗菌药物是预防CRAB的重要方式。

OBJECTIVE To identify the risk factors for nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii（CRAB）so as to provide guidance for the effective prevention and treatment.METHODS By means of case control study,the clinical data were collected from 37 patients with CRAB nosocomial infections and30 patients with carbapenem-sensitive Acinetobacter baumannii（CSAB）nosocomial infections who were treated in the hospital from May 2014 to May 2015.The non-conditional logistic regression model was established to predict the risk for the CRAB nosocomial infections.RESULTS Of 68 strains of A.baumannii causing the nosocomial infections,38 were CRAB,accounting for 55.88%.Among the patients with CRAB nosocomial infections,48.64%were from the ICU,and 43.24% were from the neurosurgery department;the patients with lower respiratory tract infections accounted for 71.05%.The incidence of CRAB nosocomial infections was associated with the ICU stay（OR=26.244）and use of carbapenems before the patients had the infections（OR=9.488）（P〈0.05）.CONCLUSION The ICU stay and use of carbapenems before the infections are the independent risk factors for the CRAB nosocomial infections.It is important to intensify the prevention measures of nosocomial infections in the ICU and reasonably use carbapenems so as to prevent the CRAB.