邢台市人民医院鲍曼不动杆菌感染因素的研究

Investigation on the factors of Acinetobacter baumannii infection in Xingtai People’s Hospital

目的分析邢台市人民医院鲍曼不动杆菌(Acinetobacter baumannii,AB)感染分布、耐药性特点和多重耐药菌(multi-drug resistant,MDR)的易感因素。方法回顾性收集126例AB感染患者的临床资料,分析AB感染分布和耐药性特点,依据有无MDR-AB分为MDR-AB组和无MDR-AB组,分析MDR-AB的易感因素,并建立MDR-AB的预测模型。结果126例AB感染患者科室分布:重症监护室(intensive care unit,ICU)34.13%、呼吸内科25.40%以及颅脑外科20.63%;感染部位:血流感染28.57%、中枢神经系统感染26.19%和泌尿系统感染26.19%。66.67%的患者存在MDR-AB感染,检出MDR-AB菌123株,AB感染病原菌对美罗培南、亚胺培南、环丙沙星、头孢吡肟、头孢他啶和头孢曲松的耐药率均超过95.00%,对左氧氟沙星、氨曲南、氨苄青霉素-舒巴坦和哌拉西林-他唑巴坦等的耐药率>70%,对米诺环素和替加环素的耐药率低。MDR-AB组年龄≥60岁、住院时间≥12 d、侵入性操作、入组APACHEⅡ评分≥20分、联合应用抗菌药物占比高于无MDR-AB组(P<0.05)。年龄、住院时间、侵入性操作、入组APACHEⅡ评分和联合应用抗菌药物是MDR-AB感染的易感因素(P<0.05)。由MDR-AB易感因素构建的预测模型预测MDR-AB感染的曲线下面积为0.895,敏感度为79.52%,特异度为89.94%。结论医院AB感染主要来源于ICU,以下呼吸道感染最为常见,对米诺环素、替加环素敏感性好,由MDR-AB易感因素建立的预测模型对MDR-AB预测有较高价值。

Objective To analyze the distribution and drug resistance characteristics of Acinetobacter baumannii(AB)infection and risk factors for multi-drug resistant(MDR)bacteria infection in Xingtai People’s Hospital.Methods The clinical data of 126 patients with AB infection were collected retrospectively.The distribution and drug resistance characteristics of AB infection were analyzed.According to the presence or absence of MDR-AB,the patients were divided into MDR-AB group and non-MDR-AB group.The risk factors of MDR-AB infection were analyzed,and a prediction model for MDR-AB infection was constructed.Results The 126 patients infected with AB were from the intensive care unit(ICU)(34.13%),department of respiratory medicine(25.40%)and department of craniocerebral surgery(20.63%).The main infection sites included bloodstream(28.57%),central nervous system(26.19%)and urinary system(26.19%).66.67%of the patients developed MDR-AB infection,and 123 MDR-AB strains were detected.The resistance rates of pathogenic bacteria of AB infection to meropenem,imipenem,ciprofloxacin,cefepime,ceftazidime and ceftriaxone were higher than 95.00%.The resistance rates to levofloxacin,aztreonam,ampicillin-sulbactam and piperacillintazobactam were higher than 70%.The resistance rates to minocycline and tigecycline were low.The proportions of patients≥60 years old,hospital stay≥12 days,invasive procedures,APACHEⅡscore at admission≥20,and combined use of antibiotics in MDR-AB group were significantly higher than those in non-MDR-AB group(P<0.05).The age,length of hospitalization,invasive procedures,APACHEⅡscore at admission and combined use of antibiotics were risk factors of MDR-AB infection(P<0.05).The area under the curve(AUC),sensitivity and specificity of the prediction model constructed based on these risk factors to predict MDR-AB infection were 0.895,79.52%and 89.94%,respectively.Conclusion Hospital AB infection mostly occurs in ICU,and lower respiratory tract infection is the most common.The pathogenic bacteria are sensitive to minocycline and tigecycline.The prediction model constructed based on risk factors of MDR-AB infection is helpful for prediction.