重症监护病房耐碳青霉烯类鲍曼不动杆菌感染患者死亡的影响因素分析

Risk factors of carbapenem resistant Acinetobacter baumannii infection in intensive care unit

目的分析可能与重症监护病房(intensive care unit,ICU)中的耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)感染患者30天内死亡率相关的临床特征和危险因素,探讨CRAB的耐药性及其对死亡率的影响。方法以2012年12月至2021年2月解放军总医院第五医学中心的173例CRAB感染的ICU患者为研究对象,收集相关资料进行回顾性分析。生存组119例(68.8%),死亡组54例(31.2%),CRAB感染患者的年龄为(52.9±13.5)岁,男性140例(80.9%)、女性33例(19.1%)。收集首次检出的CRAB,对菌株复苏后进行药物敏感试验,对抗生素的耐药性进行分析。采用单因素和多因素Cox模型分析CRAB感染患者30天内死亡率相关的独立危险因素。结果经过单因素和多因素Cox分析显示,急性生理及慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health Evaluation Scoring SystemⅡ,APACHEⅡ)(HR=1.058,95%CI:1.012~1.106,P=0.013)和感染性休克(HR=6.240,95%CI:2.227~17.483,P<0.001)为CRAB感染的ICU患者30天内死亡率相关的独立危险因素。治疗时使用β内酰胺酶抑制剂(HR=0.496,95%CI:0.275~0.893,P<0.019)会降低ICU中CRAB感染患者的30天死亡率。CRAB对头孢菌素类、碳青霉烯类、氨基糖苷类和喹诺酮类抗生素的耐药率均高于80%;对氨基糖苷类耐药CRAB引起感染的患者的生存率较低(χ^(2)=4.012,P<0.05)。结论APACHEⅡ评分、感染性休克和使用β内酰胺酶抑制剂是与ICU中CRAB感染患者30天内死亡率相关的独立因素。

Objective This study will analyze the clinical characteristics and risk factors that may be related to the 30-day mortality of patients infected with CRAB in intensive care unit(ICU),and explore the resistance of CRAB and its influence on mortality.Methods From December 2012 to February 2021,173 ICU patients with CRAB infection in the Fifth Medical Center of PLA General Hospital were selected as the research objects,and the relevant data were collected for retrospective analysis.There were 119 cases(68.8%)in survival group and 54 cases(31.2%)in the non-survival group.Patients with CRAB infection were(52.9±13.5)years old,including 140 males(80.9%)and 33 females(19.1%).The first detected CRAB was collected,and antibiotic sensitivity test was conducted after the strain was resuscitated to analyze the antibiotic resistance.Univariate and multivariate Cox models were used to analyze independent risk factors associated with 30-day mortality in patients with CRAB infection.Results Univariate and multivariate Cox analysis showed that acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)(HR=1.058,95%CI:1.012-1.106,P=0.013)and septic shock(HR=6.240,95%CI:2.227-17.483,P<0.001)were independent risk factors related to 30-day mortality in ICU patients with CRAB.Treatment withβ-lactamase inhibitor(HR=0.496,95%CI:0.275-0.893,P<0.019)can reduce the 30-day mortality of patients with CRAB infection in ICU.The resistance rate of CRAB to cephalosporins,carbapenems,aminoglycosides and quinolones were more than 80%.The survival rate of patients infected by aminoglycoside resistant CRAB is low(χ^(2)=4.012,P<0.05).Conclusion The APACHEⅡscore,septic shock and use ofβ-lactamase inhibitors were independent factors associated with the 30-day mortality in ICU patients with CRAB infection.