神经重症监护单元美罗培南耐药鲍曼不动杆菌感染的危险因素探讨

Associated Features and Risk Factors of Infections Caused by Acinetobacter baumannii Resistant to Meropenem in Neurological Intensive Care Unit

目的:探讨神经重症监护单元(NCU)患者美罗培南耐药鲍曼不动杆菌感染的相关危险因素。方法:采用回顾性研究方法,分析2013~2020年荆州市第一人民医院NCU收治的美罗培南耐药鲍曼不动杆菌感染患者(耐药组)与敏感鲍曼不动杆菌感染患者(敏感组)的相关暴露情况,并用Logistic回归分析进行美罗培南耐药鲍曼不动杆菌感染危险因素筛选。结果:耐药组患者的二代、三代、四代头孢菌素以及碳青霉烯类抗菌药物的暴露率明显高于敏感组患者(P<0.05)。耐药组患者三代头孢菌素总治疗疗程、碳青酶烯类药物使用频度(DDDs)及总治疗疗程均明显长于敏感组(P<0.05)。耐药组患者NCU住院时间及机械通气≥3 d百分比明显高于敏感组(P<0.05)。多因素Logistic回归分析提示,二代头孢菌素的使用[OR=8.872,95%CI(1.098,71.687)]、三代头孢菌素总治疗疗程≥7 d[OR=13.999,95%CI(1.917,102.227)]可能与美罗培南耐药鲍曼不动杆菌感染有关(P<0.05)。结论:二代头孢菌素的使用,以及三代头孢菌素总治疗疗程≥7 d可能增加患者发生美罗培南耐药鲍曼不动杆菌感染的风险;需加强抗菌药物合理使用,降低多药耐药鲍曼不动杆菌的医院性流行。

Objective:To investigate the associated risk factors of infections caused by Acinetobacter baumannii resistant to meropenem in neurological intensive care unit.Methods:The characteristics in patients with meropenem-susceptible Acinetobacter bacteremia infections and meropenem-resistant Acinetobacter bacteremia infections from January 2013 to December 2020 in the First People’s Hospital of Jingzhou were analyzed retrospectively.Logistic regression was carried for the risk factors about the infections caused by Acinetobacter baumannii resistant to meropenem.Results:The exposure rates of second-generation cephalosporins,third-generation cephalosporins,fourth-generation cephalosporins and carbapenems in meropenem resistant group were significantly higher than those in meropenem sensitive group(P<0.05).The total treatment course of third-generations of cephalosporins,DDDs and total treatment course of carbapenems in meropenem resistant group were significantly higher than those in meropenem sensitive group(P<0.05).These patients also had higher length of NCU stay and proportion of mechanical ventilation above three days(P<0.05).Multivariate analysis showed that the use of second-generation cephalosporin(OR=8.872,95%CI 1.098 to 71.687)and the total treatment course of third-generation cephalosporin≥7 days(OR=13.999,95%CI 1.917 to 102.227)may be related to meropenem resistant Acinetobacter baumannii infection(P<0.05).Conclusion:Exposure to second-generation cephalosporin and the total treatment course of third-generation cephalosporin≥7 days were possibly associated with meropenem-resistant Acinetobacter bacteremia.To reduce the nosocomial prevalence of multidrug-resistant Acinetobacter baumannii,we should strengthen the rational use of antibiotics.