鲍氏不动杆菌血流感染患者抗感染治疗分析

Anti-infective therapy analysis of patients with bloodstream infections caused by Acinetobacter baumannii

目的分析鲍氏不动杆菌血流感染的临床特征和抗感染治疗情况,探讨鲍氏不动杆菌血流感染的防治方法,以提高临床疗效。方法分析医院2012年5月-2015年6月确诊为鲍氏不动杆菌血流感染病例共45例,根据患者抗菌药物的应用分为碳青霉烯类治疗组、头孢哌酮/舒巴坦治疗组、碳青霉烯类-头孢哌酮/舒巴坦序贯治疗组、哌拉西林/他唑巴坦组和其他抗菌药物单药治疗组,分析患者临床特征及抗感染治疗结果。结果鲍氏不动杆菌血流感染患者抗感染治疗有效组在合并重症肺炎、APACHEⅡ评分、深静脉置管、有创机械通气、入住ICU、不恰当经验性治疗和细菌耐药性等方面与无效组相比,差异有统计学意义(P<0.05);碳青霉烯组、头孢哌酮/舒巴坦组、碳青霉烯类-头孢哌酮/舒巴坦组、哌拉西林/他唑巴坦组和其他治疗组的抗感染治疗有效比例分别为55.6%、68.8%、50.0%、85.7%、100%;患者预后与感染的鲍氏不动杆菌耐药情况密切相关,治疗无效组多重耐药菌和泛耐药菌构成比为91.7%,而有效组仅为39.4%,两组间差异具有统计学意义(P<0.05);各治疗组的抗感染治疗有效率与感染耐药菌的比例正相关。结论重症合并有重症肺炎等基础疾病的患者发生鲍氏不动杆菌血流感染的抗感染治疗预后较差,深静脉置管或有创机械通气、入住ICU、不恰当经验性治疗、多重耐药菌为其高危因素,使用碳青霉烯类或头孢哌酮/舒巴坦或二者序贯联合其他药物治疗对多重耐药菌感染有一定的疗效。

OBJECTIVE To analyze clinical characteristics and anti-infective therapy of bloodstream infections caused by Acinetobacter baumannii and explore the methods for effective therapy and prevention so as to improve clinical curative effect of this infection.METHODS The clinical data and outcomes of antibacterial therapy were reviewed retrospectively for 45 patients who were diagnosed with bloodstream infections by A.baumannii in Lishui Hospital of Zhejiang University from May 2012 to Jun.2015.These 45 patients were divided into five groups according to the application of antibiotics in patients：carbapenems group,cefoperazone/sulbactam group,carbapenems and cefoperazone/sulbactam sequential therapy group,piperacillin/tazobactam group and other antibacterial drugs monotherapy group.The clinical characteristics and anti-infection therapy results were analyzed.RESULTS The differences between effective treatment group and ineffective treatment group in severe pneumonia,APACHE II score,deep venous catheter,invasive mechanical ventilation,ICU,inappropriate empirical therapy and bacterial of patients with bloodstream infection caused by A.baumannii were significant（P〈0.05）.The rate of effective treatment of carbapenems group,cefoperazone/sulbactam group,carbapenems and cefoperazone/sulbactam sequential therapy group,piperacillin/tazobactam group and other antibacterial drugs monotherapy groups were 55.6%,68.8%,50.0%,85.7%and 100%,respectively.The prognosis was closely related to the drug resistance of A.baumannii.The proportion of multi-drug resistant A.baumannii（MDRAB）and extensively drug-resistant A.baumannii（XDRAB）in effective treatment group was 91.7% and ineffective treatment group was 39.4%.The difference between these two groups was statistically significant（P〈0.05）.The effective rate of anti-infection treatment in each treatment groups was positively correlated with the proportion of resistant strains.CONCLUSIONThe prognosis of anti-infective therapy in severe patients who was occurred bloodstream infections by A.baumannii combined with severe pneumonia was not ideal.And deep venous catheter,invasive mechanical ventilation,ICU,inappropriate empirical treatment,and multiple drug resistant bacteria were the high risk factors.The effect of anti-infective treatment in patients with non-multiple drug resistant bacteria infected was good.The treatment with carbapenems,cefoperazone/sulbactam,or sequential therapy of carbapenems and cefoperazone/sulbactam had certain curative effect of multi-drug resistant bacteria infection.