多重耐药鲍曼不动杆菌感染的相关危险因素分析

Analysis of related risk factors of multidrug-resistant acinetobacter baumannii infection

目的探讨多重耐药鲍曼不动杆菌(MDRAB)的相关危险因素,为临床合理用药提供依据。方法采用回顾性分析方法调查2016年1月至2017年12月新疆生产建设兵团系统内13家医疗机构的1359例鲍曼不动杆菌感染病人的病例资料,得出感染MDRAB的危险因素,并通过多元logistic回归分析发现独立危险因素。结果1359例鲍曼不动杆菌感染病人中老年人(75~99岁)居多有664例(占48.86%),科室分布以内科为主有916例(占67.40%),感染部位主要分布在呼吸系统有1129例(占83.08%),标本类型主要为痰液有1101例(占81.02%),多重耐药组死亡265例,病死率35.71%;非多重耐药组死亡134例,病死率21.72%。两组比较差异有统计学意义(χ2=31.819,P=0.000)。单因素分析结果显示:性别、长期卧床、两种以上基础疾病、手术、侵入操作、入住ICU、心功能不全、肝功能不全、肾功能不全、肺功能不全、合并其它细菌感染、合并真菌感染、免疫调节剂使用、喹诺酮类使用、糖肽类使用、碳青霉烯类使用、加酶抑制剂使用是MDRAB感染的危险因素。多因素分析结果显示:是否入住ICU、侵入操作、喹诺酮类使用、碳青霉烯类使用、加酶抑制剂使用是MDRAB感染的独立危险因素。结论MDRAB给临床治疗带来了极大的挑战,早期干预危险因素及合理使用抗菌药物有助于减少MDRAB的发生率。

Objective To explore the risk factors of multidrug resistant Acinetobacter baumannii(MDRAB),and to provide evi⁃dence for rational drug use in clinic.Methods The data of 1359 patients with Acinetobacter baumannii(AB)infection in 13 med⁃ical institutions of the corps system from January 2015 to December 2016 were investigated by retrospective analysis method,and the risk factors of MDRAB infection were obtained.The independent risk factors were found through multiple logistic regression analysis.Results In 1359 cases of medical records,the majority of patients with AB infection were the elderly(75⁃99 years old)(48.86%),the department distribution was mainly internal medicine(67.40%),the infection site was mainly respiratory system(83.08%),the specimen type was mainly sputum(81.02%),and the mortality rate of multidrug resistance group was significantly higher than that of non⁃multidrug resistance group(P=0.000).Single factor analysis showed that gender,long⁃term bedridden,two or more basic diseases,surgery,invasive procedures,ICU admission,cardiac insufficiency,hepatic insufficiency,renal insufficiency,pulmonary dysfunction,concomitant with other bacterial infection,the combining fungal infections,immune regulator use,quinolone use,sugar peptide use,carbapenem use,plus enzyme inhibitor use were MDRAB infection risk factors.The results of multivariate analysis showed that the presence of ICU,invasive procedures,quinolone use,carbapenem use and enzyme inhibitor use were inde⁃pendent risk factors for MDRAB infection.Conclusion MDRAB poses great challenges to clinical treatment.Early intervention of risk factors and rational use of antimicrobial agents can help reduce the incidence of MDRAB.