鲍曼不动杆菌血流感染危险因素分析

Risk Factors of Acinetobacter Baumannii Bloodstream Infection

目的探讨鲍曼不动杆菌血流感染的危险因素。方法选取某三甲医院2015年2月至2020年6月收治的鲍曼不动杆菌血流感染患者40例,根据30 d预后情况将患者分为死亡组(16例)和存活组(24例),根据耐药情况分为耐碳青霉烯类鲍曼不动杆菌(CRAB)组(28例)和碳青霉烯类敏感鲍曼不动杆菌(CSAB)组(12例),通过医院电子病历信息系统收集患者的基本信息、临床和实验室检查结果、基础疾病、微生物学数据、入住重症监护病房(ICU)时间、血流感染前侵入性操作、抗菌药物暴露、Pitt菌血症评分(PBS)、30 d全因死亡率、经验性治疗方案、目标性治疗方案。采用单因素COX回归分析鲍曼不动杆菌血流感染患者30 d死亡的危险因素,采用Logistic回归分析CRAB血流感染的危险因素,采用Kaplan-Meier曲线和时序检验比较CRAB组和CSAB组死亡率。结果使用糖皮质激素[HR=3.3,95%CI(1.2,9.2),P=0.020],PBS高[HR=1.4,95%CI(1.1,1.7),P=0.002],脓毒性休克[HR=86.0,95%CI(1.5,5072.8),P=0.030],不恰当经验性治疗[HR=8.9,95%CI(1.2,67.4),P=0.04]均显著影响鲍曼不动杆菌血流感染患者30 d的死亡率;侵入性操作[OR=19.3,95%CI(1.9,192.8),P=0.01],入住ICU[OR=25.0,95%CI(4.2,147.1),P<0.01],入住ICU时间长[OR=1.1,95%CI(1.0,1.2),P=0.04],抗菌药物暴露[OR=65.0,95%CI(8.0,526.2),P<0.01],PBS高[OR=2.1,95%CI(1.3,3.4),P<0.01]均对CRAB血流感染患者影响显著。结论鲍曼不动杆菌血流感染患者的病死率高,感染前使用糖皮质激素、感染时PBS高、合并脓毒性休克、不恰当经验性治疗提示不良预后,侵入性操作、入住ICU且时间长、抗菌药物暴露、PBS高与发生CRAB相关。

Objective To investigate the risk factors of Acinetobacter baumannii bloodstream infection.Methods Forty patients with Acinetobacter baumannii bloodstream infection admitted to a tertiary A hospital from February 2015 to June 2020 were selected and divided into the death group(16 cases)and the survival group(24 cases)according to the 30 d-prognosis condition,and they were divided into the carbapenem-resistant Acinetobacter baumannii(CRAB)group(28 cases)and the carbapenem-susceptible Acinetobacter baumannii(CSAB)group(12 cases)according to the drug resistance.The basic information,clinical and laboratory examination results,underlying disease,microbiological data,admission time in intensive care unit(ICU),invasive manipulation before bloodstream infection,antibacterial drug exposure,Pitt bacteremia score(PBS),all-cause mortality in 30 d,empirical treatment plan and targeted treatment plan of patients in the hospital electronic medical record information system were collected.The risk factors of 30 d-mortality of patients with Acinetobacter baumannii bloodstream infection were analyzed by the univariate COX regression analysis,the risk factors of CRAB bloodstream infection were analyzed by the Logistic regression analysis,the mortalities of CRAB group and CSAB group were compared by the Kaplan-Meier(K-M)curve and log-rank test.Results The use of glucocorticoids[HR=3.3,95%CI(1.2,9.2),P=0.020],high PBS[HR=1.4,95%CI(1.1,1.7),P=0.002],septic shock[HR=86.0,95%CI(1.5,5072.8),P=0.030]and inappropriate empirical treatment[HR=8.9,95%CI(1.2,67.4),P=0.04]had significant effects on the 30 d-mortality of patients with Acinetobacter baumannii bloodstream infection.Invasive manipulation[OR=19.3,95%CI(1.9,192.8),P=0.01],admission in ICU[OR=25.0,95%CI(4.2,147.1),P<0.01],prolonged ICU stay[OR=1.1,95%CI(1.0,1.2),P=0.04],antibacterial drug exposure[OR=65.0,95%CI(8.0,526.2),P<0.01]and high PBS[OR=2.1,95%CI(1.3,3.4),P<0.01]had significant effects on patients with CRAB bloodstream infection.Conclusion The mortality of patients with Acinetobacter baumannii bloodstream infection is high.The use of glucocorticoids before infection,high PBS during infection,with septic shock and inappropriate empirical treatment suggest poor prognosis.Invasive manipulation,prolonged ICU stay,antibacterial drug exposure and high PBS are associated with the incidence of CRAB.