鲍曼/醋酸钙不动杆菌复合体感染危险因素分析

Analysis of risk factors for infection of the bauman/acinetobacter acetate complex

目的对鲍曼/醋酸钙不动杆菌复合体感染的危险因素进行分析与总结,为临床提供预防的依据和方法。方法收集2015年12月至2017年12月在北京积水潭医院住院并培养出鲍曼/醋酸钙不动杆菌复合体的177例患者的临床资料进行回顾性研究。针对患者基础疾病与急性生理和慢性健康评分标准Ⅱ(APACHEⅡ)、各种侵入性操作、抗生素的使用、白蛋白、手卫生等进行单因素与多因素非条件Logistic回归分析,根据分析的结果临床采用相应的措施减少该菌的院内感染。结果共检出177株鲍曼/醋酸钙不动杆菌复合体,占革兰阴性杆菌感染的12. 3%(177/1 439)。单因素分析显示,APACHEⅡ评分、碳青霉烯类、手卫生、使用呼吸机、联合使用抗生素差、血清白蛋白降低均具有统计学意义(P <0. 05)。多因素非条件Logistic回归分析显示,APACHEⅡ评分、手卫生与机械通气是院内感染的独立危险因素。结论鲍曼/醋酸钙不动杆菌复合体对常用抗生素多数表现为耐药,治疗原发病、减少呼吸机的使用、注意手卫生能明显减少鲍曼/醋酸钙不动杆菌复合体的感染。

Objective To analyzed and sununarized the risk factors of the bauman/acinetobacter acetate complex infection and provide the basis and method for clinical prevention. Methods Data of 177 patients admitted to Beijing jishuitan hospital from December 2015 to December 2017 and cultivated the bauman/acinetobaeter acetate complex were collected for retrospective study. The clinical data were collected, and univariate and multivariate regression analysis were conducted for APACHE, various invasive operations, antibiotic use, hand hygiene albumin etc of the patients. According to the analysis results, corresponding measures were adopted to reduce the nosoconfial infection of the bacteria. Results A total of 177 bowman/acinetobacter acetate complexes were detected, accounting for 12.3 % of gram - negative bacillus infections （ 177/1 439）. The difference of APACHE Ⅱ, the use of carbapenems, hand hygiene, ventilator, combined use of antibiotics and serum albumin were statistically significant （ P 〈 0.05 ）. Multiple factors and non - conditional logistic regression analysis results showed that APACHE Ⅱ, manual hygiene and mechanical ventilation were independent risk factors for hospital infection. Conclusion The bauman/acinetobacter acetate complex shows resistance to most conunonly used antinficrobial drags, treating the primary morbidity, reducing the use of ventilators, and paying attention to hand hygiene can reduce the infection of the bauman/acinetobacter acetate complex.