| 人工气道患者碳青霉烯类抗生素耐药鲍曼不动杆菌感染相关因素分析 |
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| 引用本文： | 边伟帅,陈炜,古旭云,王锁柱,甄洁,刘平,藏学峰.人工气道患者碳青霉烯类抗生素耐药鲍曼不动杆菌感染相关因素分析[J].现代预防医学,2020,0(21):4020-4024. |
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| 作者姓名： | 边伟帅 陈炜 古旭云 王锁柱 甄洁 刘平 藏学峰 |
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| 作者单位： | 首都医科大学附属北京世纪坛医院重症医学科 北京 100038 |
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| 摘 要： | 目的 对存在碳青霉烯类抗生素耐药鲍曼不动杆菌（CRAB）肺部感染的人工气道患者进行相关因素分析，了解CRAB耐药特点。 方法 研究重症监护病房2016年1月至2019年12月收治的鲍曼不动杆菌肺部感染的268例患者，按其痰培养结果分为CRAB及碳青霉烯类抗生素敏感鲍曼不动杆菌（CSAB）两组，分析两组患者的临床特征，CRAB对常见抗生素的耐药情况，并检测相关耐药基因。 结果 鲍曼不动杆菌对亚胺培南的耐药率从2016年为51.61%，上升至2018年86.57%，2019年下降至79.45%，差异有统计学意义（〖XC五号.EPS;P〗=22.81， P <0.001）；CRAB组患者年龄、急性生理与慢性健康(APACHE)Ⅱ评分、机械通气时间、C反应蛋白（CRP）、降钙素原（PCT）、病死率等均明显高于CSAB组患者（ P <0.05）；logistic 回归分析显示:合并COPD（ OR =2.095，95% CI :0.117～1.474）、机械通气时间大于10天( OR =68.250，95% CI :3.545～5.374)及感染前使用碳青霉烯类抗生素（ OR =10.846，95% CI :1.784～3.201）是CRAB感染的危险因素。CRAB中含有AmpC、IMP、VIM、OXA-23、OXA-51、aac ( 3)–I、ant（3″）-I、aph（3＇）-VIa、gyrA、parC等多种耐药基因。 结论 重症监护病房CRAB耐药率较高，应减少碳青霉烯类抗生素的使用，缩短机械通气时间，选用敏感抗生素治疗以遏制人工气道患者的CRAB感染。
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| 关 键 词： | 鲍曼不动杆菌 重症监护病房 危险因素 耐药基因 |
Related factors of carbapenem resistant acinetobacter baumannii infection in patients with artificial airway |
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| BIAN Wei-shuai,CHEN Wei,GU Xu-yun,WANG Suo-zhu,ZHEN Jie,LIU Ping,ZANG Xue-feng.Related factors of carbapenem resistant acinetobacter baumannii infection in patients with artificial airway[J].Modern Preventive Medicine,2020,0(21):4020-4024. |
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| Authors: | BIAN Wei-shuai CHEN Wei GU Xu-yun WANG Suo-zhu ZHEN Jie LIU Ping ZANG Xue-feng |
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| Affiliation: | Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China |
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| Abstract: | To analyze the related factors of pulmonary infection caused by carbapenem resistant Acinetobacter baumannii( CRAB),and to understand the characteristics of CRAB. Methods 268 patients with pulmonary infection of Acinetobacter baumannii admitted to ICU from January 2016 to December 2019 were divided into CRAB and carbapenem antibiotic sensitive Acinetobacter baumannii( CSAB) groups according to their sputum culture results. The clinical characteristics of the two groups were analyzed and CRAB resistance to common antibiotics,and detection of related resistance genes. Results The resistance rate of Acinetobacter baumannii to imipenem increased from 51. 61% in 2016 to 86. 57% in2018,and decreased to 79. 45% in 2019,with statistical difference( χ2= 22. 81,P < 0. 001) and the age,acute physiology and chronic health( APACHE) Ⅱ score,mechanical ventilation time,C-reactive protein( CRP),procalcitonin( PCT) and mortality in CRAB group were significantly higher than those in CSAB group( P < 0. 05). Logistic regression analysis showed that CRAB infection was significantly related to COPD( OR = 2. 095,95% CI: 0. 117 ～ 1. 474),mechanical ventilation time greater than 10 days( OR = 68. 250,95% CI: 3. 545 ～ 5. 374) and using carbapenem antibiotics before infection( OR = 10. 846,95% CI: 1. 784 ～ 3. 201). CRAB contains Amp C,IMP、VIM、OXA-23、OXA-51、aac( 3)-I、ant( 3″)-I、aph( 3’)-VIa、gyr A、par C drug resistance genes. Conclusion The rate of CRAB resistance is high in ICU. We should reduce the use of carbapenem antibiotics,shorten the time of mechanical ventilation,and select sensitive antibiotics to prevent CRAB infection in patients with artificial airway. |
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| Keywords: | Acinetobacter baumannii ICU Risk factors Drug resistance gene |
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