多重耐药鲍曼不动杆菌医院感染危险因素

目的了解多重耐药鲍曼不动杆菌（MDRAB）医院感染的危险因素，为临床控制MDRAB感染，制定预防和控制措施提供依据。方法调查2011年4月-2012年9月某院鲍曼不动杆菌（AB）患者的临床资料，对AB和MDRAB科室分布、标本来源情况进行分类，了解MDRAB医院感染危险因素。 结果236株AB 中，共检出MDRAB 74株，检出率为31.36%。重症监护室（ICU）和神经外科MDRAB检出率高达60.00%（27/45）和58.06%（18/31）；MDRAB感染部位以创口（45.45%）、呼吸道（34.27%）和泌尿道（17.65%）为主。单因素分析结果显示，患者住ICU天数、血清清蛋白、使用纤维支气管镜、昏迷天数、气管切开、使用呼吸机、留置切口引流管、留置导尿管、使用碳青霉烯类抗生素以及抗菌药物使用天数，各组差异均有统计学意义（均P＜0.05）。多因素logistic回归分析结果显示，气管切开（OR95%CI：1.152~7.187）和使用呼吸机（OR95%CI：1.263~7.664）是MDRAB医院感染的危险因素。结论气管切开和呼吸机使用在MDRAB的产生和传播中起重要作用；加强医院多重耐药菌管理，对减少MDRAB感染具有重要意义。

Risk factors for multidrug resistant Acinetobacter baumannii infection

Objective To evaluate risk factors for multidrug-resistant Acinetobacter baumannii（MDRAB）infection,so as to provide reference for making preventive and control measures of MDRAB infection.Methods Clinical data of patients with Acinetobacter baumannii（A.baumannii）infection in a hospital between April 2011 and September 2012 were surveyed,distribution and specimen sources of A.baumannii and MDRAB were analyzed,and risk factors of MDRAB were assessed.Results Of 236 isolates of A.baumannii,74（31.36%）were MDRAB.The isolation rate of MDRAB in intensive care unit and neurosurgery department was up to 60.00%（27/45）and 58.06%（18/31）respectively;MDRAB were mainly isolated from wound（45.45%）,respiratory tract（34.27%）,and urinary tract（17.65%）.Univariate analysis revealed that difference in length of hospital stay,use of serum albumin,fiberbronchoscopy,coma days,tracheotomy,use of ventilator,incisional drainage,urinary catheterization,use of carbapenems,and antimicrobial days in different groups were statistically different（P〈0.05）.Multivariate logistic regression analysis revealed that tracheotomy（OR95%CI：1.152-7.187）,use of ventilator（OR95%CI：1.263-7.664）were independent risk factors for MDRAB infection.Conclusion Tracheotomy and use of ventilator play an important role in the producing and spreading of MDRAB,management on drug-resistant bacteria is important in reducing MDRAB infection.