鲍曼不动杆菌院内获得性肺炎发生和死亡的危险因素分析

Risk factors for Acinetobacter baumannii hospital.acquired pneumonia and associated mortality

目的探讨鲍曼不动杆菌（鲍氏不动杆菌）院内获得性肺炎（Ab—HAP）的易感因素和死亡的危险因素。方法收集2012-2015年北京积水潭医院明确诊断的Ab—HAP患者65例，并随机收集同期非Ab—HAP患者80例作为对照组，分析人口学、基础疾病、治疗情况及转归等信息。采用Logistic回归法分析发生Ab—HAP的独立危险因素以及Ab—HAP患者30d死亡的独立危险因素。结果Ab—HAP组和对照组在合并基础病、意识障碍、APACHⅡ评分≥16、机械通气≥5d、碳青霉烯抗生素暴露史方面差异有统计学意义（χ2=36．327、31．208、72．616、22．029和64．476，P均〈0．01）。多因素分析显示，APACHⅡ评分≥16（OR=1．140，95％CI：1．058-1．229）、碳青霉烯抗生素暴露史（OR=7，118，95％CI：1．965-25．787）是发生Ab—HAP的独立危险因素。Logistic回归分析证实，降钙素原≥2ng／mL（OR=6．020，95％CI：7．428-2819．026）、肺炎严重性评分（PSI）≥Ⅲ级（OR=4．260，95％CI：3．185—1573．536）和脓毒性休克（OR=4．186，95％CI：2．056-2104．507）是Ab—HAP患者30d死亡的独立危险因素。结论APACHⅡ评分≥16、碳青霉烯抗生素暴露史能增加Ab—HAP发生率；PSI≥Ⅲ级、降钙素原≥2ng／mL和脓毒休克是Ab—HAP患者30d死亡的独立危险因素。

Objective To study the risk factors for Acinetobacter Baumannii hospital-acquired pneumonia （Ab-HAP）. Methods Data of 65 patients diagnosed with Ab-HAP during 2012 to 2015 was collected, and 80 random cases of non-Acinetobacer Baumannii gram-negative bacterial hospital-acquired pneumonia were as control group. Information such as demographic characteristics, underlying diseases, treatment and outcomes was analyzed. Logistic regression was performed to identify the independent risk factors of Ab-HAP and risk factors for 30-day mortality. Results The differences of prevalence of underlying diseases, confusion, APACHⅡ score ≥16, mechanical vetilation ≥ 5 days and history of imipenem exposure between Ab-HAP group and control group had statistical significance （χ2=36.327, 31.208, 72.616, 22.029 and 64.476,P all〈0.01）. Multiple-factor analysis showed that APACHⅡ seore≥ 16 （0R=1.140,95%CI：1.058-1.229） and history of imipenem exposure （OR=7.118, 95%CI：1.965-25.787） were independent risk factors for Ab-HAP. Logistic regression confirmed procalcitonin ≥2 ng/mL （OR =6.020,95% CI：7.428-2 819.026）, pneumonia severvity index （PSI）≥Ⅲ risk class （ OR =4.260,95 % CI：3.185-1573.536） and septic shock （OR =4.186,95% CI：2.056-2 104.507）were associated with 30-day mortality. Conclusions APACH Ⅱ score ≥ 16 and history of imipenem exposure can increase the occurrence rate of Ab-HAP.Procalcitonin ≥2 ng/mL, PSI≥Ⅲrisk class and septic shock are risk factors for 30-day mortality of Ab- HAP.