下呼吸道鲍曼不动杆菌感染患者对亚胺培南、美罗培南和头孢哌酮舒巴坦耐药的易感因素分析

Evaluate on the risk factors of the antibiotic resistance caused by Acinetobacter baumannii pneumonia in Meropenem,Imipenem and Cefperazone-Sulbactam

目的研究影响下呼吸道鲍曼不动杆菌(Acinetobacter baumannii,AB)感染患者对亚胺培南(Imipenem,IPM)、美罗培南(Meropenem,MEM)和头孢哌酮舒巴坦(Cefperazone-Sulbactam,SCF)耐药的易感因素。方法收集下呼吸道感染患者的痰标本,分离出鲍曼不动杆菌感染944株,其中931株进行了IPM药物敏感试验,712株进行了MEM药物敏感试验,887株进行了SCF药物敏感试验,根据药物敏感试验结果分为耐药组和非耐药组,比较其多重耐药鲍曼不动杆菌(multidrug-resistant Acinetobacter baumannii,MDRAB)的检出率,比较不同性别、是否侵入性操作、是否泌尿道插管、是否气管插管、是否气管切开、是否使用呼吸机、是否进行中心静脉插管、是否手术、是否入住外科、是否入住ICU、住院次数、感染前住院时间、感染季节等不同环境条件下的耐药性,并进行Logistic回归分析。结果耐药组IPM、MEM和SCF的MDRAB检出率远高于不耐药组,差异均有统计学意义(P<0.05)。无论在IPM组、MEM组还是SCF组,男性、有侵入性操作、有泌尿道插管、有气管插管、有气管切开、应用呼吸机、行中心静脉插管、行手术、入住外科、入住ICU者均较女性、无侵入性操作、无泌尿道插管、无气管插管、无气管切开、未使用呼吸机、未行中心静脉插管、未行手术、未入住外科、未入住ICU者耐药检出率高,差异有统计学意义(P<0.05)。Logistic回归显示:使用呼吸机是促进AB对3种药物耐药概率升高的共同院内感染防控因素(P<0.05);男性、入住ICU、感染前使用抗生素≥5d和冬春季均是增加AB对IPM和MEM 2种药物耐药概率的共同危险因素(P<0.05);入住外科和住院1次均是增加AB对IPM耐药的独立危险因素(P<0.05)。结论应针对各种抗生素耐药发生的高危人群、高发季节和高发时段设计院内感染防控措施,缩短使用抗生素时间,重视早期细菌学检测,提高入院早期送检率,有效控制细菌对抗生素耐药的发生和发展。

Objective To evaluate the risk factors of the antibiotic resistance of Imipenem(IPM),Meropenem(MEM)and Cefperazone-Sulbactam(SCF)among the Acinetobacter baumannii(AB)pneumonia.Methods A total of 944 specimens from lower respiratory tract with acinetobacter baumannii pneumonia were identified:931,712 and 887 were subjected to antimicrobial susceptibility testing in IPM,MPM and SCF,respectively.The difference in the rate of multidrug-resistant Acinetobacter baumannii(MDRAB)and the clinical characteristics between the dichotomized resistant group and non-resistant group in the three antimicrobial susceptibility testing were analyzed,respectively.Then we used Logistic regression analysis to evaluate the risk factors.Results The MDRAB rates of the resistant group were higher than the non-resistant group in the three antibacterial agents(P<0.05).There were significant differences in sex,the use of invasive operation,urinary tract intubation,trachea cannula,tracheotomy,ventilator,central venous catheter,surgery,internal or surgical department,intensive care unit,times of hospitalization,hospital stays and season between the dichotomized resistant group and non-resistant group in IPM,MEM and SCF(P<0.05).Logistic regression analysis suggested that the use of ventilator before delivery could increase the risk of these three antibiotic-resistance(P<0.05).While AB-pneumonia patients in men,intensive care unit,the antibiotic-use-days≥5 d and Spring-Winter could be easily resistant to both IPM and MEM(P<0.05).And resistance to IPM may easily happened in surgical department and only one time-hospitalization(P<0.05).Conclusion he prevention and control measures should be designed according to the high-risk population,the high-incidence season and the high-occurrence period of each kind of drug-sensitive drug resistance,so as to shorten the time of antibiotic use,attach importance to the daily bacterial detection,improve the early detection rate at admission,and effectively control the occurrence and development of bacterial resistance to antibiotics.