鲍曼不动杆菌院内感染的危险因素和耐药性分析

Risk factors and drug resistance regression analysis of nosocomial infections caused by Acinetobacter baumannii

目的探讨综合重症监护病房(ICU)患者鲍曼不动杆菌感染的危险因素及耐药性,为临床对鲍曼不动杆菌感染的预防和合理使用抗菌药物提供决策依据。方法 144例ICU患者,将72例鲍曼不动杆菌培养阳性患者作为研究组,72例鲍曼不动杆菌培养阴性患者作为对照组,对两组患者入住ICU时间长短、广谱抗菌药物使用时间、侵入性医疗操作(人工气道/机械通气)等因素进行回顾性对比分析,探讨ICU住院患者鲍曼不动杆菌感染危险因素,同时采用K-B纸片法分析该病的耐药性。结果研究组入住ICU时间≥7 d、使用广谱抗菌药物≥7 d、侵入性医疗操作、感染时白蛋白<25 g/L、留置尿管≥7 d患者占比高于对照组,差异有统计学意义(P<0.05)。研究组鲍曼不动杆菌院内感染的高危因素与入住ICU时间≥7 d有关[OR=3.450,95%CI(1.605,7.416),P<0.05];与使用广谱抗菌药物≥7 d有关[OR=3.707,95%CI(1.673,8.214),P<0.05];与侵入性医疗操作有关[OR=5.365,95%CI(2.376,12.116),P<0.05];与低白蛋白血症有关[OR=3.145,95%CI(1.705,6.436),P<0.05];与留置导尿管≥7 d有关[OR=4.374,95%CI(3.176,11.516),P<0.05]。72例送检阳性标本分布,痰液检出率80.56%,尿液标本9.72%、伤口分泌物4.17%、血液2.78%、脑脊液1.38%、静脉导管1.38%。药敏结果显示:鲍曼不动杆菌对阿米卡星、阿莫西林克拉维酸、氨曲南、美洛培南等抗菌药物耐药率很高,呈现出广泛多重耐药趋势。对大多数青霉素类、头孢类、碳青霉烯类和喹诺酮类抗菌药物耐药率均>90%,对头孢哌酮舒巴坦耐药率>70%;对米诺环素耐药率为16.67%,对替加环素耐药率为29.17%。结论 ICU患者住院时间长、广谱抗菌药物的使用时间长、侵入性治疗方式的运用、低蛋白血症、留置尿管≥7 d是鲍曼不动杆菌感染的高危因素。分别有针对性的纠正上述因素,对防止患者鲍曼不动杆菌感染有实验性参考价值;经验用药时应该避免阿莫西林克拉维酸、氨曲南等高耐药抗菌药物的使用。

Objective To explore the risk factors and drug resistance of Acinetobacter baumannii infection in general intensive care unit（ICU） patients, and to provide decision-making basis for the prevention and rational use of antibacterials for Acinetobacter baumannii infection. Methods In 144 ICU patients, among them, 72 patients with Acinetobacter baumannii culture positive were regarded as the research group, and another 72 patients with Acinetobacter baumannii culture negative were regarded as the control group. The length of ICU stay, the use time of broad-spectrum antibacterials and invasive medical procedures（artificial airway/mechanical ventilation） and other factors between the two groups were compared and analyzed retrospectively, the risk factors of Acinetobacter baumannii infection in hospitalized patients of ICU were investigated, at the same time, the drug resistance of the disease was analyzed by K-B paper method. Results In the research group, the proportion of ICU stay for equal or more than 7 d, using broad-spectrum antibacterials for equal or more than 7 d and invasive medical procedures patients were significantly higher than those in the control group, the differences were statistically significant（P0.05）. In the research group, the proportion of serum less than 25 g/L and the indwelling catheter for equal or more than 7 d patients nosocomial infections caused by Acinetobacter baumannii in the research group were related to equal or more than 7 d of ICU stay [OR=3.450, 95%CI（1.605, 7.416）, P0.05], using broad-spectrum antibacterials for equal or more than 7 d [OR=3.707, 95%CI（1.673, 8.214）, P0.05], the invasive medical procedures [OR=5.365, 95%CI（2.376,12.116）, P0.05], hypoalbuminemia [OR=3.145, 95%CI（1.705, 6.436）, P0.05] and indwelling catheter for equal or more than 7 d [OR=4.374, 95%CI（3.176, 11.516）, P0.05]. The distribution of positive specimens in 72 cases： the detection rate of sputum specimens was 80.56%, the detection rate of urine specimen was 9.72%, the detection rate of wound secretion was 4.17%, the detection rate of blood was 2.78%, the detection rate of cerebrospinal fluid was1.38%, the detection rate of venous catheter was 1.38%. The drug susceptibility results showed that the resistance rate of Acinetobacter baumannii to antibacterials such as Amikacin, Amoxicillin and Clavulanate, Aztreonam and Meropenem is high, and showed a widespread multidrug resistance trend. The resistance rates of most penicillins, cephalosporins, carbapenems and quinolones were above 90%, the resistance rate of cefoperazone sulbactam was over 70%, the resistance rate of minocycline was 16.67%, and the resistance rate of tigecycline was 29.17%. Conclusion ICU patients with long hospital stay, long time use of broad-spectrum antibacterials, the application of invasive treatment, hypoproteinemia, indwelling catheter for equal or more than 7 d are the high risk factors for Acinetobacter baumannii infection. Targeted correction of the above factors has experimental reference value to prevent patients with Acinetobacter baumannii infection. The use of Amoxicillin and Clavulanate, Aztreonam and other highly resistant antibacterials should be avoided in the experience of drug use.