ICU肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素及耐药性分析
Risk factors and drug resistance of MDR Acinetobacter baumannii in pneumonia patients with ICU

常金来.ICU肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素及耐药性分析[J].内科急危重症杂志,2017,23(4):

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英文关键词:ICU MDR Acinetobacter baumannii pneumonia drug resistance risk factors

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作者	单位	E-mail
常金来	北京市大兴区人民医院	2570310569@qq.com

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中文摘要:

目的：调查ICU肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素，分析其耐药性情况。方法：2013年1月到2016年2月选择入住我院ICU病房后诊断为泛耐药鲍曼不动杆菌肺炎患者98例作为观察组，同期按照2:1的比例选择在我院ICU病房诊治的非泛耐药鲍曼不动杆菌肺炎患者49例作为对照组，两组都采集痰液标本进行耐药性分析，同时调查了泛耐药鲍曼不动杆菌感染的危险因素与预后情况。结果：观察组对于头孢噻肟、哌拉西林、亚胺培南、庆大霉素、左氧氟沙星、四环素、头孢他啶都高度耐药，仅对多粘菌素敏感。除哌拉西林、多粘菌素外，对照组对其他抗菌药物的耐药率均明显低于观察组(P<0.05)。单因素分析显示糖尿病、感染前住院时间、入院24h内APACHEⅡ评分、GCS评分、深静脉置管、机械通气等因素与 ICU 内泛耐药鲍曼不动杆菌性肺炎显著相关(P<0.05)。非条件 Logistic回归分析，结果显示糖尿病、感染前住院时间、入院24h内APACHEⅡ评分、GCS评分导致泛耐药鲍曼不动杆菌感染的独立危险因素(P<0.05)。结论：ICU肺炎患者中泛耐药鲍曼不动杆菌感染比较常见，糖尿病、感染前住院时间、入院24h内APACHEⅡ评分、GCS评分为主要的危险因素，其对于绝大多数抗菌药物有耐药性，可导致患者预后变差与随访死亡率增加。

英文摘要:

Objective: To investigate the risk factors and drug resistance of MDR Acinetobacter baumannii in pneumonia patients. Methods: From January 2013 to February 2016, 98 pneumonia patients with MDR Acinetobacter baumannii in our hospital ICU were selected as the observation group, and 49 pneumonia patients with not-MDR Acinetobacter baumannii in our hospital ICU were selected as the control group in accordance with the proportion of 2:1. Two groups were collected sputum samples for drug resistance, and the risk factors and prognosis of MDR Acinetobacter baumannii in pneumonia patients were given survey analysis. Results: The observation group were highly resistant for cefotaxime, piperacillin, imipenem, levofloxacin, gentamicin, tetracycline and ceftazidime, and were only sensitive to polymyxin. In addition to piperacillin, polymyxin B, the other antimicrobial drug resistance rates in the control group were significantly lower in the observation group (P<0.05). Univariate analysis showed that diabetes, infection before hospitalization, admission 24h score of APACHE Ⅱ and GCS scores, deep venous catheterization, mechanical ventilation were related to the MDR Acinetobacter baumannii in pneumonia patients(P<0.05). Non conditional Logistic regression analysis showed that diabetes mellitus, infection before hospitalization, admission 24h score of APACHE Ⅱ and GCS scores were the independent risk factors for the MDR Acinetobacter baumannii in pneumonia patients(P<0.05). Conclusion: MDR Acinetobacter baumannii in pneumonia patients with ICU is common, diabetes, infection before hospitalization, admission 24h score of APACHE Ⅱ and GCS scores are the main risk factors, and the vast majority of the antibiotics are resistance to the MDR Acinetobacter baumannii that can lead to poorer prognosis and followed-up of patients with increased mortality.