2010至2016年某三甲医院鲍曼不动杆菌血流感染临床分析及耐药性变迁

Clinical analysis and trend in antimicrobial resistance of Acinetobacter baumannii bloodstream infection in a tertiary hospital from 2010 to 2016

目的探讨鲍曼不动杆菌血流感染的临床特征及耐药性变迁。方法回顾性分析湖南省人民医院2010年1月至2016年6月114例鲍曼不动杆菌血流感染患者的基础疾病、危险因素、临床特点、实验室检查结果、发病时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、细菌药敏结果以及治疗转归。结果本研究中纳入的114例鲍曼不动杆菌血流感染患者均合并严重原发感染病灶或基础疾病,在血流感染前2周均接受至少1种以上有创操作。114株分离菌株中以耐药菌株居多,其中多重耐药鲍曼不动杆菌89株,占78.1%;药敏结果显示替加环素耐药率最低(12.3%),其次为阿米卡星(55.3%),头孢哌酮舒巴坦的耐药率为61.4%;死亡59例,总病死率51.8%。多重耐药菌株感染患者病死率62.9%,非多重耐药菌株感染患者病死率12.0%(χ2=20.268,P<0.001)。多重耐药菌株感染患者入住重症监护病房比例、气道开放比例以及APACHEⅡ评分显著高于非多重耐药菌株感染患者(P<0.05)。抗菌治疗方案中,以替加环素为基础的治疗组的病死率(60.0%)低于非替加环素治疗组(64.8%),差异无统计学意义(P>0.05)。结论鲍曼不动杆菌血流感染耐药率及病死率高,且以多重耐药菌株感染为主。入住重症监护病房、开放气道以及疾病严重程度是影响多耐药鲍曼不动杆菌血流感染患者病死率的危险因素。以替加环素为基础的治疗方案并未改善多重耐药鲍曼不动杆菌血流感染患者的预后。

Objective To review the clinical features and trend in antimicrobial resistance of Acinetobacter baumannii（A. baumannii） bloodstream infections. Methods Retrospective analysis was performed by collecting data of underlying diseases, potential risk factors, clinical characteristics, blood test results, Acute Physiology and Chronic Health EvaluationⅡ（APACHEⅡ） scores at onset, bacterial resistance to antibiotics and antimicrobial therapy were collected in Hunan Provincial People＇s Hospital from January 2010 to June 2016. Results There were 114 non-duplicated A. baumannii complex blood isolates identified in this research. All patients had at least one underlying disease and accepted at least one surgery or invasive operation within the past 14 days. Multidrug-resistant A. baumannii（MDRAB）was isolated from 89（78.1%） patients. Of the 114 strains of A. baumannii, 12.3% were resistant to tigecycline, 55.3% to amikacin and 61.4% to cefoperazone-sulbactam. The overall mortality was 51.8%（59/114）. The patients with MDRAB had higher mortality rate than those with non-MDRAB（62.9% vs. 12.0%, χ~2=20.268, P0.001）. With higher incidence of being in the intensive care unit, intubation/tracheotomy and increased APACHEⅡ score among patients with MDRAB bacteremia（P〈0.05）. Compared with subjects treated with tigecycline based regimen, those treated with non tigecycline for multidrug resistant A. baumannii had a higher mortality（64.8% vs. 60.0%） but there was no statistical significance（P〉0.05）. Conclusions The isolated A. baumannii are mainly multidrug resistant and with high mortality. Being in the intensive care unit, increased APACHEⅡ score and intubation/tracheotomy were risk factors for higher mortality among patients with MDRAB bloodstream infection. Tigecycline based regimen doesn＇t improve patients＇ prognosis.