脓毒症患者鲍曼不动杆菌感染及其多重耐药性影响因素分析

Analysis of infection status of Acinetobacter baumanniiand influencing factors of its multidrug resista in patientswith sepsis

目的 本研究旨在分析脓毒症患者中鲍曼不动杆菌感染的情况,并探讨其多重耐药性的影响因素及其对患者预后的影响。方法 选取2022年1月至2023年12月期间在本院确诊的脓毒症患者180例。收集患者的临床资料,包括年龄、性别、基础疾病、感染部位、抗生素使用史、住院时间等。通过微生物学检测记录鲍曼不动杆菌的分离情况及其药敏试验结果。采用单因素分析筛选潜在影响因素,随后采用多因素logistic回归分析评估影响鲍曼不动杆菌多重耐药性的独立预测因素。此外,比较不同耐药性菌株患者的预后,包括病死率、并发症发生率,并使用多因素logistic回归分析评估影响患者预后的独立危险因素。结果 在180例脓毒症患者中,鲍曼不动杆菌感染率为28.9%(52/180)。感染部位主要集中在呼吸道(26例,占50%)、泌尿道(15例,占28.8%)、血液系统(11例,占21.2%)、腹腔(7例,占13.5%)、皮肤软组织(6例,占11.5%)、中枢神经系统(4例,占7.7%)和骨关节(3例,占5.8%)。药敏试验结果显示,鲍曼不动杆菌对头孢菌素类、氨基糖苷类、喹诺酮类、碳青霉烯类等多种常用抗生素表现出高耐药性,其中多重耐药菌株65.38%(34/52)。多因素logistic回归分析表明,抗生素使用史(OR=4.26,95%CI=1.85~9.83,P<0.05)、住院时间(OR=1.20,95%CI=1.07~1.35,P<0.05)、肾功能不全(OR=3.50,95%CI=1.39~8.81,P<0.05)以及使用激素治疗(OR=3.16,95%CI=1.15~8.66,P<0.05)是影响脓毒症患者中鲍曼不动杆菌多重耐药性的独立危险因素。多重耐药性菌株脓毒症患者的病死率为41.2%(14/34),显著高于非多重耐药性菌株患者(22.2%,4/18,P<0.05)。此外,多重耐药性菌株脓毒症患者的并发症发生率(55.9%vs 33.3%,P<0.05)也显著高于非多重耐药性菌株患者。多因素logistic回归分析显示,鲍曼不动杆菌多重耐药性(OR=2.78,95%CI=1.31~5.88,P<0.05)是影响脓毒症患者预后的独立危险因素。结论 鲍曼不动杆菌在脓毒症患者中具有较高的感染率和多重耐药性,其多重耐药性受抗生素使用史、住院时间、肾功能不全、使用激素治疗等因素的显著影响。多重耐药性菌株对脓毒症患者预后具有不良影响,包括更高的病死率和并发症发生率。

Objective This study aims to analyze the incidence of Acinetobacter baumanniinfection in patients with sepsis and to investigate the factors influencing its multidrug resistance(MDR)and its impact on patient prognosis.Methods A total of 180 sepsis patients diagnosed at our hospital from January 2022 to December 2023 were selected.Clinical data were collected,including age,gender,underlying diseases,infection sites,history of antibiotic usage,and hospitalization duration.Microbiological testing was conducted to record the isolation of A.baumannii and its antibiotic susceptibility results.Univariate analysis was used to screen potential influencing factors,followed by multivariate logistic regression analysis to evaluate independent predictors of A.baumannii MDR.Additionally,the prognosis of patients with different resistance profiles,including mortality and complication rates,was compared,and multivariate logistic regression analysis was used to assess independent risk factors affecting patient prognosis.Results sAmong the 180 sepsis patients,the infection rate of A.baumanni was 28.9%(52/180).The primary infection sites were the respiratory tract(26 cases,50%),urinary tract(15 cases,28.8%),bloodstream(11 cases,21.2%),abdominal cavity(7 cases,13.5%),skin and soft tissue(6 cases,11.5%),central nervous system(4 cases,7.7%),and bone and joints(3 cases,5.8%).Antibiotic susceptibility testing revealed that A.baumannii exhibited high resistance to multiple commonly used antibiotics,including cephalosporins,aminoglycosides,quinolones,and carbapenems,with a MDR rate of 65.38%(34/52).Multivariate logistic regression analysis indicated that history of antibiotic usage(OR=4.26,95%CI=1.85-9.83,P<0.05),hospitalization duration(OR=1.20,95%CI=1.07-1.35,P<0.05),renal insufficiency(OR=3.50,95%CI=1.39-8.81,P<0.05),and steroid treatment(OR=3.16.95%CI=1.15-8.66,P<0.05)were independent predictors of A.baumannii MDR.The mortality rate of sepsis patients with MDR strains was 41.2%(14/34),significantly higher than that of patients with non-MDR strains(22.2%,4/18,P<0.05).Additionally,the complication rate in sepsis patients with MDR strains(55.9%vs.33.3%,P<0.05)was significantly higher than that in patients with non-MDR strains.Multivariate logistic regression analysis showed that A.baumanniMDR(OR=2.78,95%CI=1.31-5.88,P<0.05)was an independent risk factor for poor prognosis in sepsis patients.ConclusionA.baumannii exhibits a high infection rate and MDR in sepsis patients.Its MDR is significantly influenced by factors such as history of antibiotic usage,hospitalization duration,renal insufficiency,and steroid treatment.MDR strains adversely affect patient prognosis,including higher mortality and complication rates.