四川省二级综合医院耐碳青霉烯类鲍曼不动杆菌感染发生的相关危险因素分析

目的探讨四川省二级综合医疗机构耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant acinetobacter baumannii, CRAB)的耐药情况及相关临床危险因素。 方法采取回顾性病例-对照研究方法，调查2015年1月至2016年1月四川地区6家二级甲等综合医院鲍曼不动杆菌感染患者病例，根据药敏结果分为CRAB组和碳青霉烯敏感组(CSAB)。 结果共收集到非重复Ab菌株202株，其中CRAB 90株，耐药率40.1%。CRAB发生的4个独立危险因素为留置尿管(OR＝9.576，95%CI：4.964～18.474，P＝0.000)、中央静脉置管(OR＝2.707，95%CI：1.158～6.330，P＝0.022)、氟喹诺酮类(OR＝3.869，95%CI：1.603～9.377，P＝0.003)及碳青霉烯类抗菌药物(OR＝2.755，95%CI：1.164～6.521，P＝0.021)的使用。 结论二级综合医院CRAB感染的发生与侵袭性操作、氟喹诺酮类及碳青霉烯类等抗菌药物的选择压力有关。

Related risk factors of carbapenem-resistant Acinetobacter baumannii in second-level general hospitals of Sichuan province

ObjectiveTo explore the related risk factors of carbapenem-resistant Acinetobacter baumannii in second-level general hospitals of Sichuan province. MethodsA retrospective case-control study was performed, and the patients with Acinetobacter baumannii infection in the 6 second-level comprehensive hospitals in Sichuan province from January 2015 to January 2016 were selected for this study. According to the drug sensitivity results, the patients were divided into a carbapenem-resistant Acinetobacter baumannii (CRAB) group and a carbapenem-sensitive Acinetobacter baumannii (CSAB) group. ResultsA total of 202 strains of non-repeated Acinetobacter baumannii were collected, among which 90 strains were resistant to carbapenem. The resistance rate of Acinetobacter baumannii to carbapenem was 40.1%. There were four independent risk factors for CRAB infections: urinary catheterization (OR=9.576, 95%CI=4.964~18.474, P=0.000), central venous catheterization (OR=2.707, 95%CI=1.158~6.330, P=0.022), the use of fluoroquinolone (OR=3.869, 95%CI=1.603~9.377, P=0.003), and the application of carbapenem antibiotics (OR=2.755, 95%CI=1.164~6.521, P=0.021). ConclusionCRAB occurrence may be related with the invasive procedure and the selection pressure of fluoroquinolone and carbapenem antibiotics in second-level comprehensive hospitals.