神经外科ICU患者感染鲍氏不动杆菌的耐药性及危险因素分析

Drug resistance of Acinetobacter baumannii causing infections in ICU patients of neurosurgery department and analysis of risk factors

目的观察神经外科ICU鲍氏不动杆菌感染情况,分析鲍氏不动杆菌的耐药性及危险因素,为临床治疗提供依据。方法选取2013年1月-2015年12月浙江省金华市中心医院神经外科ICU 995例住院患者为研究对象,其中101例鲍氏不动杆菌感染患者为感染组,101例未发生医院感染的患者为对照组;统计神经外科ICU鲍氏不动杆菌的感染情况、耐药性及抗菌药物的使用情况,对比两组患者的临床资料对鲍氏不动杆菌感染的危险因素进行分析。结果 995例住院患者中,鲍氏不动杆菌感染101例,感染率为10.2%;共分离出鲍氏不动杆菌164株;单纯鲍氏不动杆菌感染76例(75.2%),混合感染为25例(24.8%);多药耐药菌感染52例(51.5%),泛耐药菌感染35例(34.7%);鲍氏不动杆菌对庆大霉素、妥布霉素、头孢他啶、氨曲南、头孢呋辛、头孢噻肟、磺胺甲噁唑/甲氧苄啶、头孢哌酮等耐药率分别为91.5%、90.2%、88.4%、83.5%、80.5%、75.6%、72.6%、70.1%,对亚胺培南和美罗培南的敏感率分别为75.6%和73.8%;101例患者中使用1、2、3、4、5种及以上抗菌药物者分别为4、8、18、20、51例,分别占4.0%、7.9%、17.8%、19.8%、50.5%;鲍氏不动杆菌感染组白蛋白<35g/L和GCS评分≤8分比例高于对照组(P<0.05),感染组机械通气和头部引流管率均高于对照组;白蛋白水平、GCS评分和头部引流管为鲍氏不动杆菌感染的独立危险因素(P<0.05)。结论神经外科ICU鲍氏不动杆菌感染率较高,鲍氏不动杆菌耐药性严重,白蛋白水平、GCS评分和头部引流管是鲍氏不动杆菌感染的独立危险因素。

OBJECTIVE To observe the prevalence of Acinetobacter baumannii infections in ICU of neurosurgery department and analyze the drug resistance of the A.baumannii and the risk factors for the infections so as to provide guidance for clinical treatment.METHODS A total of 995 patients who were hospitalized the ICU of neurosurgery department of Central Hospital of Jinhua City from Jan 2013 to Dec 2015 were recruited as the study objects,101 patients who were infected with A.baumannii were assigned as the infection group,and 101 patients who did not have nosocomial infections were set as the control group.The prevalence of A.baumannii infections in the ICU of neurosurgery department,drug resistance,and status of use of antibiotics were statistically analyzed,the clinical data of the two groups of patients were observed and compared,and the risk factors for the A.baumannii infections were analyzed.RESULTS Of 995 hospitalized patients,101 had the A.baumannii infection,with the infection rate 10.2%.Totally 164 strains of A.baumannii were isolated.Totally 76 （75.2%） patients had single A.baumannii infections,and 25 （24.8%） patients had mixed infections.There were 52 （51.5%） patients with multidrug-resistant organisms infections and 35 （34.7 %） patients with pandrug-resistant bacteria infections.The drug resistance rates of the A.baumannii strains to gentamicin,tobramycin,ceftazidime,aztreonam,cefuroxime,cefotaxime,sulfamethoxazole-trimethoprim,and cefoperazone were 91.5%,90.2%,88.4%,83.5%,80.5%,75.6 %,72.6 %,and 70.1%,respectively;the drug susceptibility rates to imipenem and meropenem were 75.6 % and 73.8%,respectively.Among the 101 patients,4 （4.0%） patients used 1 type of antibiotic,8 （7.9%） patients used 2 types of antibiotics,18 （17.8%） patients used 3 types of antibiotics,20 （19.8%） patients used 4 types of antibiotics,and 51 （50.5%） patients used no less than 5 types of antibiotics.The proportions of the patients with the albumin level less than 35 g/L and the GCS score no more than 8 points were significantly higher in the infection group than in the control group （P〈0.05）.The rates of mechanical ventilation and head drainage tube were higher in the infection group than in the control group.The albumin level,GCS score,and head drainage tube were the independent risk factors for the A.baumannii infections （P〈0.05）.CONCLUSION The prevalence rate of A.baumannii infections is relatively high in the ICU of neurosurgery department,and the A.baumannii strains are highly drug-resistant.The albumin level,GCS score,and head drainage tube are the independent risk factors for the A.baumannii infections.