重症监护室多重耐药鲍曼不动杆菌感染的危险因素分析

目的探讨ICU多重耐药鲍曼不动杆菌（MDR-B）感染的危险因素。方法采用病例对照研究，收集苏州大学附属第一医院综合重症监护室（SICU）2005年1月至2008年12月MDR．AB感染34例，并随机选择同时期普通鲍曼不动杆菌感染52例作为对照，应用单因素分析（t检验和x。检验）及多因素非条件Logistic回归分析MDR—AB感染的危险因素。结果单因素分析发现，感染前急性生理和慢性健康评分标准11（APACHEⅡ）评分、序贯性器官功能衰竭（SOFA）评分升高，机械通气，使用第三代头孢菌素类、碳青霉烯抗生素，以及抗生素使用〉7d与MDR—AB感染有关。多因素非条件Logistic回归分析发现，第三代头孢菌素的使用（OR=6．411，95％CI1．984-0．716）及APACHEⅡ评分（DR=1．247。95％CI1．025-1．517）、SOFA评分（（OR=1．622，95％CIL．182—2．226）的升高是发生MDR—AB感染的独立危险因素。结论临床上应依据APACHEⅡ和SOFA评分来预判MDR—AB感染的可能性，合理使用第三代头孢菌素，以控制MDR—AB引起的院内感染。

Analysis of risk factors infected by multidrug resistant acinetobacter baumannii in synthesizes intensive care unit

Objective To study the risk factors of muhidrug resistant acinetobacter baumannii （MDR-AB） in synthesizes intensive care unit. Methods The data of 34 eases infected by MDR-AB from Jan. 2005 to Dec. 2008 was analyzed in synthesizes intensive care unit. All 52 cases infected by common acinetobacter baumannii were selected randomly at the same time as control. Univariate analysis （t test and chisquare test ） and multivariate Logistic regression were used for statistical analysis. Results Univariate analysis revealed that six factors associated with the infection caused by MDR-AB were acute physiology and chronic health evaluation II （APACHE ]l ）score, sequential organ failure assessmen （SOFA） score, mechanical ventilation, therapy with third generation cephalosporin and carbapenem antibiotics and the duration of antibiotics used for more than 7 days. Multivariate logistic regression analysis identified three independent factors including with third generation eephalosporin （ OR = 6. 411, 95% CI 1. 984-20.716） , APACHE 1] score （ OR = 1. 247, 95% CI 1. 025-1. 517） and SOFA score （ OR = 1. 622, 95% CI 1. 182-2. 226）. Conclusions The possibility of MDR-AB infection should be judged in advance according to the APACHE II score and SOFA score. The third generation cephalosporin should be used rationally for controlling the infection of MDR-AB.