ICU患者耐碳青酶烯鲍曼不动杆菌阳性危险因素探讨

Evaluating Risk Factors for ICU Patients with CR-Acinetobacter baumannii Positive

目的 探讨与ICU患者临床标本耐碳青酶烯鲍曼不动杆菌 (Carbapenem risistantAcinetobacterbaumannii ,CRA .b)阳性相关的危险因素 ,评估联合使用多种感染控制措施的有效性 ,为临床预防CRA .b的爆发流行提供依据。方法 对 2 0 0 0年 9月至 2 0 0 1年 11月间西南医院ICU患者进行前瞻性纵向干预调查并对临床标本鲍曼不动杆菌阳性患者进行分析。结果 通过CRA .b阳性患者和对碳青酶烯敏感的鲍曼不动杆菌 (Carbapenem susceptibleAcinetobacterbaumannii,CSA .b)阳性患者危险因素的比较 ,发现CRA .b阳性患者多有碳青酶烯类抗生素使用史、所在病房中CRA .b阳性患者较多、肠道携带CR Ab的比率较高。联合采取了多种感染控制措施后 ,新患者临床标本鲍曼不动杆菌的阳性检出率大幅度下降。结论 限制碳青酶烯类抗生素的使用 。

Objective To identify risk factors for the development of clinical colonization or infection due to CR Acinetobacter baumannii,to evaluate the efficacy of a combination of infection control measures,and to provide evidence for clinical prevention of CRA.b outbreak.Methods We conducted a prospective longitudinal intervention investigation that focused on ICU patients of Southwest Hospital between September 2000 and November 2001 and analyzed those patients with A.baumannii in clinical samples.Results Risk factors were compared between the CRA.b infected or colonized patients and the CSA.b infected or colonized patients. A higher proportion of CRA.b infected or colonized patients had received therapy with carbapenems, had been admitted into a ward with a high density of CRA.b infected or colonized patients, and were more frequently previous state of CRA.b carriage.The implementation of the multicomponent infection control measures resulted in a sharp reduction in the incidence rate of new A.baumannii infection or colonization.Conclusion Restriction of carbapenem use and strict compliance with basic infection control measures may have a strong impact on controlling A.baumannii outbreaks.