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耐碳青霉烯类鲍曼不动杆菌感染危险因素分析:一项病例-病例-对照研究 被引量:8

Case-case-control study of risk factors of carbapenem-resistant Acinetobacter baumannff infection
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摘要 目的探讨影响碳青霉烯类耐药鲍曼不动杆菌(CRAB)感染的危险因素,为临床CRAB的诊治和预防提供依据。方法对天津医科大学总医院2011年1月至2015年12月无菌体液中细菌培养阳性的病例资料进行回顾性分析,按1:1:1设计病例一病例一对照研究,CRAB感染组68例,碳青霉烯类敏感鲍曼不动杆菌(CSAB)感染组68例,并在匹配患者中随机选取68例无菌体液中培养出非鲍曼不动杆菌阳性患者作为对照。对鲍曼不动杆菌感染的危险因素进行单因素分析,将单因素分析中差异有统计学意义的因素进行多因素Logistic回归。结果单因素分析中,CRAB组与对照组比较发现,菌血症/脓毒血症、使用碳青霉烯类抗生素、使用β-内酰胺酶抑制剂复合制剂、使用替加环素、联合使用抗菌药物、使用糖皮质激素,1个月内进行过手术、机械通气、中央静脉插管、动脉穿刺、留置导尿管≥3d、胃管插管均为CRAB感染的危险因素(x^2=4.96、15.56、7.64、9.22、5.89、6.80、17.00、11.83、18.22、8.24、25.24和7.70,P〈0.05或〈0.01);CSAB组与对照组比较,使用三代头孢菌素、中央静脉插管、分离菌株前总的住院时间为CSAB感染的危险因素(x^2=11.93和6.94,U=1555,P〈0.05)。多因素Logistic回归分析中,菌血症/脓毒血症[OR=4.01,95%可信区间(CI):1.13~14.20)、使用碳青霉烯类抗生素(OR=4.17,95%CI:1.79~9.73)、中央静脉插管(OR=2.93,95%CI:1.22~7.08)、留置导尿管≥3d(OR=6.08,95%C1:2.39~15.46)为CRAB感染的独立危险因素;使用三代头孢菌素(OR:3.98,95%CI:1.88~8.43)、中央静脉插管(OR=3.40,95%CI:1.48~7.81)为CSAB感染的独立危险因素。结论长期使用碳青霉烯类抗生素及进行侵入性操作是CRAB感染的危险因素,临床上应合理使用抗菌药物,最大限度地减少患者的有创操作,降低CRAB的感染。 Objective To assess the risk factors of carbapenem-resistant Acinetobacter baumannii (CRAB) infection. Methods Clinical data of patients with positive bacterial culture in Tianjin Medical University General Hospital during January 2011 and December 2015 were retrospectively analyzed, including 68 patients with carbapenem resistant Acinetobacter baumannii (CRAB) bacteremia, 68 patients with carbapenem sensitive Acinetobacter baumannii (CSAB) bacteremia, and 68 patients with positive culture of other bacteria ( control group). The risk factors ofAcinetobacter baumannii infection were analyzed by univatiate and multivariate Logistic regression analyses. Results Univariate analysis showed that bacteremia/sepsis,use of carbapenems, 13-1actamase inhibitor compound, tigecycline, combined antibiotics, glucocorticoids, surgery within one month, mechanical ventilation, central venous catheters (CVCs), arteriopuncture,indwelling catheters〉3 days and indwelling gastric tube were risk factors of CRAB infection(CRAB vs. control: x^2 =4.96, 15.56,7.64,9.22,5.89,6.80, 17.00, 11.83,18.22,8.24,25.24 and 7.70, P 〈 0. 05 or P 〈 0. 01, respectively) ; while use of third-generation cephalosporin, CVCs, length of hospital stay were risk factors of CSAB infection ( CSAB vs. control: x^2 = 11.93 and 6. 94, U = 1555, P 〈 0. 05 ). Multivariate logistic analysis showed that bacteremia/sepsis ( OR = 4. 01, 95% CI: 1.13 - 14. 20), use ofcarbapenems (OR=4.17, 95%CI :1.79-9.73), CVCs (OR=2.93, 95% CI: 1. 22 - 7. 08 ) , indwelling catheters〉3 days ( OR = 6. 08,95% CI: 2. 39 - 15.46) were independent risk factors of CRAB infection ; use of third-generation cephalosporin ( OR = 3.98, 95% CI : 1.88 - 8.43 ), CVCs ( OR = 3.40, 95% CI:1. 48 - 7.81 ) were independent risk factors of CSAB infection. Conclusions Long-term use of carbapenems and invasive procedures are associated with CRAB infection, strict control of invasive procedures and rational use of antibiotics may reduce CRAB irrfection.
出处 《中华临床感染病杂志》 2016年第3期224-229,共6页 Chinese Journal of Clinical Infectious Diseases
基金 天津市应用基础与前沿技术研究计划(15JCYBJC26300)
关键词 鲍氏不动杆菌 抗药性 多药 危险因素 病例-病例-对照研究 Acinetobacter baumannii Drug resistance, multiple Risk factors Case-case- control study
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参考文献19

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