重症监护室鲍曼不动杆菌感染的临床现状及耐药性变迁

Analysis of Prognostic Risk Factors in Patients Infected by Acinetobacter Baumannii in Hospital’s Intensive Care Unit

目的:探讨ICU鲍曼不动杆菌感染的临床现状及耐药性变迁。方法:对2014年1月至2017年12月北京中医药大学东直门医院东区重症监护室(ICU)住院的158例鲍曼不动杆菌感染患者的临床资料,包括逐年分离率、菌株来源、预后及耐药情况等进行回顾性分析。结果:ICU鲍曼不动杆菌感染率为12.2%,死亡率19.6%,菌株分离率呈逐年下降趋势,菌株来源以呼吸道痰液为主,是引起ICU患者肺部感染特别是呼吸机相关性肺炎的主要条件致病菌。鲍曼不动杆菌耐药菌株占65.2%,多种广谱抗生素耐药率呈逐年上升趋势。鲍曼不动杆菌感染患者死亡组较存活组年龄大、ICU入住时间短、机械通气率高,但无统计学意义,使用多种抗生素和菌株耐药方面差异有统计学意义。结论:我院ICU成立时间短,鲍曼不动杆菌感染率高,分离率呈下降趋势,耐药率逐年升高,有效治疗药物较少,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。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,以期减少鲍曼不动杆菌的感染和传播。

Objective: To investigate clinical status and Antibiotics for drug-resistance of Acinetobacter baumannii (AB) infection in ICU. Methods: The clinical data of 158 patients with Acinetobacter baumannii infection hospitalized in the East Intensive Care Unit (ICU) of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine from January 2014 to December 2017 were retrospectively analyzed, including annual isolation rate, strain source, prognosis and drug resistance. Results: The infection rate of AB was 12.2%, the mortality was 19.6%, and the isolation rate of strains decreased year by year. The source of the strain was mainly respiratory sputum, which was the main cause of pulmonary infection in ICU patients, especially ventilator-associated pneumonia. The antibiotics drug-resistant of AB accounted for 65.2%, and the resistance rate of various broad-spectrum antibiotics showed an increasing trend annual. The death group infected by AB was older、shorter remained in ICU、higher usage of mechanical ventilation, However There is no statistically significant (P>0.05). There were significant differences in drug resistance between multiple antibiotics and strains. Conclusion: The ICU of our hospital has been established for a short time, the infection rate of Acinetobacter baumannii is high, the isolation rate shows a downward trend, the drug resistance rate increases year by year, and the effective treatment drugs are few. The use of multiple antibiotics and strain resistance are risk factors for the death of Acinetobacter baumannii infected patients. In order to reduce the infection and transmission of Acinetobacter baumannii, we should strengthen the concept of infection control, interrupt the transmission of Acinetobacter baumannii and strengthen the clinical management of antibiotics.