鲍曼不动杆菌院内感染及相关危险因素分析

Hospital Infection and Related Risk Factors of Acinetobacter Baumannii

目的了解鲍曼不动杆菌院内感染分布情况,分析危险因素,为指导临床治疗提供依据。方法用Microscan Walkaway 96型自动微生物鉴定仪进行细菌鉴定,用纸片扩散法对菌株进行药物敏感试验,试验结果用Whonet 5.6软件进行检测和分析。结果共分离出菌株4 863株,其中鲍曼不动杆菌352株,数量居第4位,主要分布在神经外科(35.22%)、呼吸科(15.06%)和重症监护室(ICU,13.64%);经单因素分析,多重耐药与非多重耐药患者比较,抗生素的使用情况、感染前住院天数、机械通气、气管切开插管因素占比差异均有统计学意义(P<0.05);经多因素分析,使用碳青霉烯类抗生素、使用抗生素天数超过7 d、机械通气是多重耐药鲍曼不动杆菌的独立危险因素。结论在院内感染中,鲍曼不动杆菌主要分布于神经外科、呼吸科和ICU,抗生素的应用情况、感染前住院天数、机械通气、气管切开插管与鲍曼不动杆菌感染有关,使用抗生素天数超过7 d、机械通气、使用碳青霉烯类抗生素是独立危险因素。

Objective To understand the distribution of hospital infection of Acinetobacter baumanni i , and analyze the risk factors, so as to provide the basis for clinical treatment. Methods The bacteria were identified by Microscan Walkaway 96 automatic microbial iden-tification instrument, and the drug susceptibility test was carried out by kirby - bauer method. The test results were detected and ana-lyzed by Whonet 5.6 software. Results Totally 4 863 strains were isolated. Among them, 352 strains of Acinetobacter baumannii were ranked the fourth, mainly distributed in Department of Neurosurgery （35.22% ）,Department of Respiration （15.06% ） and ICU （13. 64% ）. Single factors analysis showed that there were statistically significant differences in the use of antibiotics,the length of hos-pital stay before infection, mechanical ventilation and tracheostomy tubes between the multidrug resistant（MDR） group and non - MDR group（ P 〈 0.05）. Multiple factors analysis showed that the use of carbapenem antibiotics, antibiotics for more than 7 d, mechanical ventilation were the independent risk factors for MDR Acinetobacter baumannii. Conclusion In the hospital infection, Acinetobacter baumannii mainly distributed in the Department of Neurosurgery, Department of Respiration and ICU, the use of antibiotics, the length of hospital stay before infection, mechanical ventilation and tracheostomy tubes are related to the infection of Acinetobacter baumannii. The use of antibiotic for more than 7 d, mechanical ventilation, and use of carbapenem antibiotics were the independent risk factors for Acinetobacter baumannii infection.