耐碳青霉烯鲍曼不动杆菌血流感染危险因素分析及其治疗

Analysis of risk factors and treatment for bloodstream infection due to carbapenem resistant Acinetobacter baumannii

目的探讨耐碳青霉烯鲍曼不动杆菌(carbapenem resistant Acinetobacter baumannii, CRAB)血流感染(bloodstream infections,BSI)患者危险因素及治疗方案,为CRAB感染提供参考依据。方法回顾性总结分析我院近5年AB BSI患者,根据药敏结果,分为碳青霉烯耐药AB(CRAB)组与碳青霉烯敏感AB(carbapenem susceptible Acinetobacter baumannii,CSAB)组,分析危险因素。将CRAB BSI患者分为替加环素组与非替加环素组,比较其临床特征及预后。结果合并感染性休克、合并低蛋白血症、使用呼吸机、消化道插管、确诊前使用激素、抗生素使用3d后白细胞数量≥12×10^(9)/L是CRAB血流感染独立危险因素。CSAB组28天病死率为12.5%,而CRAB组为56.70%,明显高于CSAB组,(P值<0.001)。替加环素组28d病死率为58.82%,非替加环素组为55.56%(P>0.05)。结论 CRAB血流感染病死率高,合并感染性休克、使用呼吸机、消化道插管、合并低蛋白血症、确诊前使用激素、抗生素使用3d后白细胞数量≥12×10^(9)/L提示预后差。替加环素并未明显降低患者28d病死率改善预后。

Objective To explore the risk factors and treatment of patients with carbapenem resistant Acinetobacter baumannii(CRAB) bloodstream infection(BSI), and to provide references for CRAB infection. Methods AB BSI patients in our hospital in the past five years were retrospectively summarized and analyzed. According to the drug susceptibility results, they were divided into carbapenem-resistant AB(CRAB) group and carbapenem-susceptible AB(carbapenem susceptible to Acinetobacter baumannii, CSAB) group to analyze the risk factors. CRAB BSI patients were divided into a tigacycline group and a non-tigacycline group to compare their clinical features and prognosis. Results With septic shock, the use of glucocorticoid and gastrointestinal intubation, with hypoproteinemia, the use of hormone before diagnosis, and WBC count ≥12×10^(9)/L after 3 days of antibiotics were independent risk factors for CRAB bloodstream infection. The 28-day mortality rate in the CSAB group was 12.5%, while that in the CRAB group was 56.70%, significantly higher than that in the CSAB group(P<0.001). The 28-day mortality rate was 58.82% in the tegacycline group and 55.56% in the non-tegacycline group(P>0.05). Conclusion The mortality of CRAB bloodstream infection is high, with septic shock, and the use of glucocorticoid and gastrointestinal intubation, with hypoproteinemia, the use of hormonebefore diagnosis, and WBC count ≥12×10^(9)/L after 3 days of antibiotic use indicate poor prognosis. Tegacycline did not significantly reduce 28-day mortality rate and improve prognosis.