耐碳青霉烯类鲍曼不动杆菌耐药性及感染危险因素分析

Analysis of drug resistance and risk factors for infection of Carbapenemresistant Acinetobacter baumannii

目的探讨耐碳青霉烯类鲍曼不动杆菌（CRAB）耐药现状及其感染的危险因素，为临床合理使用抗生素及防控CRAB提供科学依据。方法回顾性调查广东医学院附属南山医院（以下简称“我院”）2014年l～12月鲍曼不动杆菌（AB）感染的住院患者的临床资料，分为碳青霉烯类抗生素敏感鲍曼不动杆菌（CSAB）组与CRAB组，将其对19种抗菌药物的耐药情况进行统计。并应用SPSS软件分析CRAB医院感染的危险因素。结果CSAB组对大多数抗菌药物敏感率〉90％，而CRAB组对大多数抗菌药物耐药率〉90％。两组对米诺环素和替加环素均没有出现耐药菌株；多因素Logistic回归分析表明，人住ICU天数（OR=2．771，95％CI：1．670～4．59）、使用抗菌药物天数（OR=1．076，95％CI：1．021—1．13）、使用呼吸机（OR=4．627，95％U：1．919～11．15）和使用碳青霉烯类抗生素（OR=2．980，95％CI：1．033～8．59）是我院CRAB感染的独立危险因素。结论抗菌药物选择性压力和外源性感染途径在CRAB的产生和传播中起到非常重要的作用，加强医院多重耐药菌感染管理，合理使用抗菌药物，对减少CRAB感染具有重要意义。

Objective To investigate drug resistance and risk factors for infection of Carbapenem-resistant A cinetobac- ter baumannii （CRAB）, moreover provide scientific basis for rational use of antibiotics in clinic and early prevention- control of CRAB infections. Methods Retrospective statistics were performed for the clinical data of inpatients with Acinetobacter baumannii infection in Nanshan Hospital Affiliated to Guangdong Medical College （＂our hospital＂ for short） from January 2014 to December 2014, patients were divided into CSAB group and CRAB group, and resistance to 19 antimicrobial agents were surveyed, also risk factors of CRAB were analyzed by SPSS. Results The sensitive rates of CSAB to most antimicrobial agents were up to 90%, while the resistant rates of CRAB to those drugs were up to 90%. No resistant isolate of these two groups was found to Minocycline and Tigecycline. Multivariate Logistic regression analysis revealed that days stayed at ICU （OR = 2.771, 95%CI： 1.670-4.59）, use of ventilator （OR = 1.076, 95%CI： 1.021-1.13）, days used of antimicrobial agents （OR = 4.627, 95%CI： 1.919-11.15） and use of carbapenem agents （OR = 2.980, 95%CI： 1.033-8.59） were independent risk factors for CRAB infection in our hospital. Conclusion Selective pressures of antimicrobial drugs and exogenous route of infection play an important role in the producing and spreading of CRAB, in that case, strengthen management of hospital on multi-drug resistant organism and rational use of antibi- otics in clinic are significant to reducing CRAB infection.