ICU肺部感染并鲍曼不动杆菌分离阳性患者临床特征及预后

Anaiysis of Clinical Manifestations and Risk Factors of Mortality due to Acinetobacter Baumannii Positive Pulmonary Infection in ICU

目的通过分析下呼吸道分泌物中分离出鲍曼不动杆菌的肺部感染患者其临床特征、对常用抗菌药物的耐药性及预后,探讨其死亡相关的危险因素。方法回顾性分析2012年6月~2017年6月郑州大学第五附属医院ICU下呼吸道分泌物分离出鲍曼不动杆菌的肺部感染患者其临床资料,包括人口学资料、基础疾病、细菌耐药性、发病时APACHEⅡ评分、抗菌药物治疗方案;依据患者28天预后结果分为死亡组和存活组;通过单因素分析和多因素Logistic回归分析死亡相关的危险因素。结果本研究共纳入98例患者,共分离出110株鲍曼不动杆菌,对头孢哌酮舒巴坦耐药率较低(17株);对美罗培南(88株)、亚胺培南(80株)的耐药率较高。28天病死率54.1%;死亡危险因素分析结果显示:合并冠心病(OR=38.3,95%CI:1.81~720.10,P=0.019)、高APACHEⅡ评分(OR=3.47,95%CI:1.30~12.81,P=0.043)、高降钙素原水平(OR=2.78,95%CI:1.30~7.02,P=0.023)、APTT延长(OR=1.32,95%CI:1.03~1.71,P=0.037)为患者28天死亡的独立危险因素;APACHEⅡ评分与死亡组患者鲍曼不动杆菌培养阳性后的生存时间呈负相关(r=-0.601,P=0.000);是否应用对鲍曼不动杆菌敏感的抗菌药物未明确影响预后。结论肺部感染并鲍曼不动杆菌分离阳性患者合并冠心病、高APACHEⅡ评分、高降钙素原水平、APTT延长为患者28天死亡的独立危险因素;尤其是合并冠心病及基础疾病的严重程度决定患者的预后。

Objective To analyze the clinical manifestations,bacterial resistance to antibiotics and risk factors of mortality in pneumonia patients with Acinetobacter baumannii（ AB） positive in respiratory secretions. Methods Clinical datas of pneumonia patients with AB positive in respiratory secretions in ICU from June 2012 to June 2017 were analyzed. According to the 28 day survival after diagnosis,the patients were divided into death group and survival group. Univariate and multivariate Logistic analysis were used to examine the risk factors of AB positive patients. Results This study included 98 patients. The 28 day mortality was 54. 1%. The independent risk factors of mortality were： merge coronary heart disease（ OR = 38. 3,95% CI： 1. 81-720. 10,P = 0. 019）,high APACHEⅡscore（ OR = 3. 47,95% CI： 1. 30-12. 81,P = 0. 043）,prolonged APTT（ OR = 1. 32,95% CI： 1. 03-1. 71,P = 0. 037）,high levels of PCT（ OR = 2. 78,95% CI： 1. 30-7. 02,P = 0. 023）. APACHEⅡscores and patients died from AB culture positive time was significantly negative correlation,r =-0. 601,P = 0. 000. Whether the application of antibiotics for AB was not clearly affected by the prognosis. Conclusion Merge coronary heart disease,high APACHEⅡscore,prolonged APTT,high levels of PCT are independent risk factors for AB culture positive patients. In particular,merge coronary heart disease and the severity of the underlying disease determine the patient＇s prognosis.