某院耐碳青霉烯类鲍曼不动杆菌感染的危险因素分析

  目的  探讨影响耐碳青霉烯类鲍曼不动杆菌(carbapenem resistant Acinetobacter baumannii，CRAB)感染的危险因素，为感染防控和临床治疗提供依据。   方法  选取海口市第三人民医院2017年1月—2019年12月鲍曼不动杆菌(Acinetobacter baumannii，AB)感染患者572例为研究对象，根据药敏结果分为CRAB组(387例)和碳青霉烯类敏感鲍曼不动杆菌(carbapenems sensitive Acinetobacter baumannii，CSAB)组(185例)，收集2组患者的临床相关资料。应用单因素及多因素logistic回归分析CRAB感染的危险因素。   结果  572例AB感染患者中，CRAB感染率为67.66%(387/572)。单因素分析显示，CRAB组和CSAB组的糖尿病史、慢性肺部疾病史、使用切口引流管、支气管镜检、使用肾上腺糖皮质激素、使用替加环素、使用碳青霉烯类抗生素及使用β-内酰胺酶抑制剂类抗生素比较，差异均有统计学意义(均P < 0.05)。多因素logistic回归分析显示，糖尿病史(OR=2.884，95% CI:1.105~7.206)、使用切口引流管(OR=5.106，95% CI:1.834~14.270)、支气管镜检(OR=4.497，95% CI:1.704~12.365)、使用替加环素(OR=3.514，95% CI:1.482~8.945)及使用碳青霉烯类抗生素(OR=5.282，95% CI:2.146~15.308)是CRAB感染的危险因素(均P < 0.05)。   结论  CRAB感染的危险因素较多，应加强CRAB感染患者的管理，合理使用抗菌药物，以减少CRAB感染率。 

Risk factors of carbapenem-resistant Acinetobacter baumannii infection in a hospital

  Objective  To explore and analyse risk factors affecting carbapenem-resistant Acinetobacter baumannii (CRAB) infection in our hospital and to provide evidence for infection prevention and control and clinical treatment.   Methods  From January 2017 to December 2019, 572 patients with Acinetobacter baumannii (AB) infection in our hospital were selected as the research objects. According to the results of drug sensitivity, they were divided into the CRAB group (387 cases) and carbapenem-sensitive Acinetobacter baumannii (CSAB) group (185 cases). The clinical data of both groups were collected. Single-factor and multivariate logistic regression were used to analyse the risk factors of CRAB infection.   Results  Amongst 572 patients with AB infection, the CRAB infection rate was 67.66% (387/572). Univariate analysis showed that history of diabetes, chronic lung disease, use of incision drainage tube, bronchoscopy, use of adrenal glucocorticoids, use of tigecycline, use of carbapenem antibiotics and use β-lactamase inhibitor antibiotics of CRAB group and CSAB group were statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that diabetes history (OR=2.884, 95% CI: 1.105-7.206), use of incision drainage tube (OR=5.106, 95% CI: 1.834-14.270), bronchoscopy (OR=4.497, 95% CI: 1.704-12.365), use of tigecycline (OR=3.514, 95% CI: 1.482-8.945) and use of carbapenem antibiotics (OR=5.282, 95% CI: 2.146-15.308) were risk factors for CRAB infection (all P < 0.05).   Conclusion  Many risk factors are associated with CRAB infection. The management of patients with CRAB infection should be strengthened, and antibiotics should be used rationally to reduce the CRAB infection rate.