医院获得性肺炎预后及鲍氏不动杆菌感染危险因素分析

Prognosis of hospital-acquired pneumonia and risk factors for Acinetobacter baumannii infections

目的对医院患者感染鲍氏不动杆菌(AB)发生的医院获得性肺炎(HAP)的危险因素和HAP患者的预后进行回顾性分析,为预防和治疗医院获得性肺炎尤其是鲍氏不动杆菌感染的HAP提供依据。方法选取2014年1月-2015年12月医院HAP患者114例,通过多元logistic回归因素进行分析,评价HAP患者感染鲍氏不动杆菌的危险因素与HAP预后相关的危险因素。结果 114例HAP患者中发生呼吸机相关性肺炎15例,痰培养为鲍氏不动杆菌29例,患者病死率为43.0%;感染前30天内入住ICU、机械通气、使用碳青霉烯类抗菌药物为感染鲍氏不动杆菌的HAP独立危险因素;感染时APACHEII评分>18、合并ARDS、合并休克是HAP死亡的独立危险因素。结论对于ICU患者、有机械通气史患者要警惕鲍氏不动杆菌感染风险,尽量减少ICU住院日及机械通气时间;临床上滥用碳青霉烯类抗菌药物会增加住院患者感染鲍氏不动杆菌风险,HAP患者感染时APACHEⅡ评分可以预估患者的预后。

OBJECTIVE To investigate the risk factors for hospital-acquired pneumonia（HAP）in patients with Acinetobacter baumannii infections and retrospectively analyze the prognosis of the patients with HAP so as to provide guidance for prevention and treatment of HAP,especially the HAP induced by A.baumannii infections.METHODS A total of 114 patients with HAP who were treated in the hospital from Jan 2014 to Dec 2015 were enrolled in the study.The multivariate logistic regression analysis was performed,the risk factors for the A.baumannii infections in the HAP patients were evaluated,and the related risk factors for prognosis of HAP were observed.RESULTS Of the 114 patients with HAP,15 had ventilator-associated pneumonia,the A.baumannii strains were cultured from sputum specimens of 29 patients,the mortality rate of the patients was 43.0%.The admission to ICU within 30 days before the infections,mechanical ventilation,and use of carbapenems were the independent risk factors for the HAP induced by A.baumannii infections.The APACHEII score more than 18 points,complication with ARDS,and complication with shock were the independent risk factors for death of the patients with HAP.CONCLUSIONIt is necessary to be aware of the risk of A.baumannii infections in the ICU patients or the patients with history of mechanical ventilation and try to shorten the length of ICU stay and mechanical ventilation duration as much as possible.The clinical abuse of carbapenems may increase the risk of A.baumannii infections in the hospitalized patients.The APACHEⅡscore may facilitate the estimation of the prognosis of the HAP patients with the infections.