我院ICU鲍曼不动杆菌感染患者预后的危险因素分析

Analysis of risk factors for prognosis of patients with Acinetobacter baumannii infection in ICU of our hospital

目的分析我院ICU鲍曼不动杆菌感染患者死亡预后的危险因素。方法回顾性分析2014年1月～2017年12月我院重症监护室(ICU)住院的158例鲍曼不动杆菌感染患者的临床资料,依据患者28 d的预后结果分为存活组和死亡组,应用单因素分析及多因素Logistic回归分析,计算OR值及95%CI,确立感染患者死亡预后的相关危险因素。结果我院ICU鲍曼不动杆菌感染菌株来源以下呼吸道痰液为主(91.8%),感染患者机械通气率为72.8%,多种抗生素使用率为44.9%,耐药率为65.2%。经单因素分析显示,使用多种抗生素和菌株耐药是鲍曼不动杆菌感染患者死亡的危险因素,再进行Logistic多因素回归分析显示两者同样是导致鲍曼不动杆菌感染患者死亡的预后因素。结论我院ICU鲍曼不动杆菌感染患者存在高龄、机械通气率高、多种抗生素使用率高等情况,且耐药情况严重。使用多种抗生素和菌株耐药是鲍曼不动杆菌感染患者死亡的危险因素和预后因素。临床上应增强感染控制理念、阻断鲍曼不动杆菌的传播途径、加强抗菌药物临床管理、根据PK/PD调整抗生素使用方案、减少鲍曼不动杆菌的耐药等,以期加强对鲍曼不动杆菌感染的防控和改善感染患者的预后。

Objective To analyze the risk factors of prognosis in patients with Acinetobacter baumannii infection in our intensive care unit(ICU).Methods A retrospective analysis of 158 cases clinical data of patients with Acinetobacter baumannii infection in the ICU of our hospital from January 2014 to December 2017 was conducted.The patients were divided into survival group and death group according to the 28-day prognosis.The univariate analysis(chi-square test and t test)and multivariate logistic regression analysis were used to calculate the odds ratio(OR)value with 95%confidential interval(CI),and to determine the relevant risk factors for the prognosis of infected patients.Results The source of Acinetobacter baumannii infection strains in our ICU were mainly from sputum of lower respiratory tract accounting for 91.8%.In these infected patients,the mechanical ventilation rate was 72.8%,the usage of multiple antibiotics was 44.9%,and the drug resistance rate was 65.2%.The univariate analysis showed that multiple antibiotics usage and drug resistance of strains were risk factors for death in patients with Acinetobacter baumannii infection.Multivariate Logistic regression analysis also displayed that the above-mentioned two factors were the prognostic ones leading to death of patients with Acinetobacter baumannii infection.Conclusion The patients with Acinetobacter baumannii infection in our hospital characterized advanced age,high mechanical ventilation rate,high antibiotic use rate,and serious drug resistance of strains.It found that the use of multiple antibiotics and drug resistance of strains are risk factors and prognostic factors for death in patients with Acinetobacter baumannii infection.Clinical measures of strengthening infection control,cutting off the route of transmission of Acinetobacter baumannii,intensifying the clinical management of antibacterial drugs,adjusting the antibiotics regimen according to PK/PD,and reducing the resistance of Acinetobacter baumannii should be taken in order to strengthen the prevention and control of Acinetobacter baumannii infection and improve prognosis in infected patients.