重症监护病房多重耐药鲍曼不动杆菌感染的危险因素分析

Analysis of risk factors for infections of multi-drug resistant Acinetobacter baumannii in intensive care unit

目的探讨重症监护病房(ICU)多重耐药鲍曼不动杆菌(Ab)感染的危险因素。方法以180例确诊Ab感染的ICU患者作为研究对象,将72例多重耐药Ab感染患者作为多重耐药组,将108例非多重耐药Ab感染患者作为非多重耐药组,对两组患者的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯性器官功能衰竭(SOFA)评分、手术、侵入性操作、抗生素使用情况及分离出的Ab菌株的耐药性进行观察和比较。采用SPSS 17.0统计软件进行统计分析,计量资料用均数±标准差(xˉ±s)表示,采用t检验,计数资料用率(%)表示,采用χ~2检验,多因素Logistic回归方法进行相关性分析。P<0.05为差异有统计学意义。结果多重耐药组患者的APACHEⅡ评分、SOFA评分及行气管插管/切开、应用第三代头孢、应用碳青霉烯类抗生素、抗生素使用时间>7 d的患者比例均高于非多重耐药组(t=4.508、2.967,χ~2=8.585、13.594、7.642、6.136,P<0.05);多因素Logistic回归分析结果显示,应用第三代头孢(OR=3.425)、感染前APACHEⅡ(OR=1.246),感染前SOFA评分(OR=1.716)、行气管切开/插管(OR=2.657)与多重耐药鲍曼不动杆菌感染呈正相关关系(OR=3.425、1.246、1.716、2.657,P<0.05)。结论在ICU患者中分离出的Ab菌株的耐药性较高,较差的健康状态和器官功能、抗生素的不合理应用和气道侵入性操作是发生多重耐药Ab感染的独立危险因素。

Objective To explore the risk factors for infection of multi-drug resistant Acinetobacter baumannii(Ab) in intensive care unit(ICU). Methods One hundred and eighty ICU patients with Ab infection were enlistedin this study. The 72 patients infected with multi-drug resistant Ab were treated as the multi-drug resistance group, while the rest of the 108 patients infected with the non-multi-drug resistant Ab were treated as the non- multi- drug resistance group. The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and the sequential organ failure assessment(SOFA) score,the operation condition, the invasive operation, the usage of antibiotics as well the drug resistance of the isolated Ab strain were observed and compared.Statistical analysis of the data was performed using SPSS 17.0 software. The continuous measure data was expressed as mean± standard deviation and analyzed using t test. The count data was expressed as ratios and compared using χ2test. Multi-factor logistic regression was performed to reveal the correlation among the facto. And P values smaller than 0.05 indicates statistical significance. Results Among the multi-drug resistance, the APACHE Ⅱscore, SOFA score, the ratios of the patients treated with endotracheal intubation/incision, the ratios with the third generation cephalosporins, the ratios with the carbapenems, and the ratios with the antibiotics application time >7 d were higher than those of the non-multi-drug resistance group(t=4.508,2.967; χ2=8.585, 13.594, 7.642, 6.136, respectively, with all P<0.05). The multiple logistic regression analysis showed that the application of the third generation cephalosporins(OR=3.425), APACHE II score before the infection(OR=1.246), SOFA score before the infection(OR=1.716), the application of endotracheal intubation/incision(OR=2.657) was positively correlated with the infection of multi-drug resistant Ab(all P<0.05). Conclusions The poor health status and organ function, the unreasonable application of antibiotics, and the invasive operation of airway are the risk factors for the infection of multi-drug resistant Ab.