耐碳青霉烯类鲍曼不动杆菌重症监护感染患者30天死亡风险及其危险因素研究

30-day mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii in intensive care unit

目的分析耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)检出患者的临床特征、死亡风险及其危险因素,为CRAB防控提供依据。方法选择2018年1月—2021年12月在四川省人民医院重症监护病房(intensive care unit,ICU)的送检标本中检出鲍曼不动杆菌的住院患者。将纳入患者分别划分为CRAB感染组、碳青霉烯类抗生素敏感的鲍曼不动杆菌(carbapenem-sensitive Acinetobacter baumannii,CSAB)感染组和CRAB定植组。使用生存分析方法对CRAB感染患者的死亡风险及其影响因素进行分析。结果共纳入患者696例,其中,CRAB感染392例,CRAB定植267例,CSAB感染37例。增加CRAB 30 d死亡风险的因素包括输血或使用血制品、机械通气、呼吸衰竭、最大降钙素原和年龄。Kaplan-Meier分析结果显示,CRAB感染组的30 d死亡风险高于CSAB感染组(χ^(2)=4.837,P=0.028),CRAB感染组30 d死亡风险与CRAB定植组差异无统计学意义(χ^(2)=0.219,P=0.640)。结论CRAB感染患者的死亡风险较高,相对于感染状态,患者30 d死亡风险更多归因于耐药状态,有效控制CRAB死亡率的方法应重点放在减少CRAB的医院获得率。

Objective To analyze the clinical characteristics,mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumanni(CRAB),so as to provide references for the prevention and control of CRAB.Methods Inpatients with Acinetobacter baumanni were selected from the clinical samples in the intensive care unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital between January 2018 and December 2021.The patients were divided into CRAB infection group,carbapenem-sensitive Acinetobacter baumannii(CSAB)infection group and CRAB colonization group.Survival analysis was used to analyze the mortality risk and its influencing factors in patients with CRAB infection.ResultsA total of 696 patients were included.Among them,there were 392 cases of CRAB infection,267 cases of CRAB colonization,and 37 cases of CSAB infection.The factors that increased the 30-day mortality risk of CRAB mainly included blood transfusion or use of blood products,mechanical ventilation,respiratory failure,maximum procalcitonin and age.Kaplan-Meier analysis showed that the 30-day mortality risk of CRAB infection group was higher than that of CSAB infection group(χ^(2)=4.837,P=0.028),there was no significant difference between CRAB infection group and CRAB colonization group in 30-day mortality risk(χ^(2)=0.219,P=0.640).Conclusions The mortality risk of CRAB infected patients is higher.Compared with the infection status,the 30-day mortality risk of patients is more attributed to drug resistance status.The effective method to control the mortality rate of CRAB should focus on reducing the hospital acquisition rate of CRAB.