鲍曼不动杆菌临床流行病学特点及耐亚胺培南鲍曼不动杆菌感染的危险因素研究

Clinical epidemiological characteristics of Acinetobacter baumannii and risk factors of imipenem resistant Acinetobacter baumannii infection

目的:探讨鲍曼不动杆菌(AB)临床流行病学特点及耐亚胺培南鲍曼不动杆菌(IRAB)感染的危险因素。方法:收集2016-01-2017-08期间的非重复AB 100株。根据亚胺培南的药物敏感性结果,把AB分为IRAB组和亚胺培南敏感鲍曼不动杆菌(ISAB)组。统计两组的临床科室分布、标本类型和危险因素,采用卡方检验和多因素Logistic回归分析数据。结果:61.00%(61株)的AB是IRAB。IRAB组对哌拉西林、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、环丙沙星、左氧氟沙星、阿米卡星和庆大霉素的耐药率明显高于ISAB组(P<0.05)。62.30%(38株)的IRAB和35.90%(14株)的ISAB来源于ICU,78.69%(48株)的IRAB和56.41%(22株)的ISAB来源于痰液标本。住ICU>7d、侵入性操作、抗菌药物使用>7d、住院时间>30d和使用碳青霉烯类抗菌药物均是IRAB感染的独立危险因素。结论:AB的耐药形势严峻,IRAB更为严重。AB和IRAB主要来源于ICU和痰液标本。IRAB感染的独立危险因素众多。

Objective：To investigate the clinical epidemiological characteristics of Acinetobacter baumannii（AB）and risk factors of imipenem resistant Acinetobacter baumannii infection（IRAB）.Method：One hundred strains of no repetition AB were collected from January 2016 to August 2017.According to the drug sensitivity of imipenem,AB was divided into IRAB group and imipenem sensitive Acinetobacter baumannii（ISAB）group.The distribution of clinical departments,specimen types and risk factors of the two groups were statistically analyzed.Chi square test and multivariate logistic regression were used to analyze the data.Result：The AB of 61%（61 strains）was IRAB.The resistance rate of piperacillin,ceftazidime,cefepime,piperacillin/tazobactam,Cefoperazone/sulbactam,ciprofloxacin,levofloxacin,gentamicin and Amikacin in group IRAB were significantly higher than those in group ISAB（P〈0.05）.Sixty-two point three zero percent（38 strains）of IRAB and 35.90%（14 strains）of ISAB were originated from ICU,and 78.69%（48 strains）of IRAB and 56.41%（22 strains）of ISAB were originated from sputum specimens.Hospitalization in ICU7 d,Invasive procedures,the use of antibacterial drugs7 d,length of stay30 dand the use of carbapenem antibiotics were independent risk factors of IRAB infection.Conclusion：AB drug resistance situation is grim,IRAB is more serious.AB and IRAB were mainly originated from ICU and sputum specimens.There are many independent risk factors of IRAB infection.