耐碳青霉烯类鲍曼不动杆菌血流感染患者危险因素及预后

目的探讨住院患者血流感染耐碳青霉烯类鲍曼不动杆菌(CRAB)的危险因素及预后。方法采用病例对照研究,回顾性收集某院2010—2013年CRAB血流感染患者163例,并以同期68例对碳青霉烯类敏感的鲍曼不动杆菌(CSAB)血流感染患者作为对照,进行危险因素及预后分析。结果 CRAB血流感染的独立危险因素是感染前入住重症监护病房(ICU)OR及OR95%CI:1.27(5.55~22.89)]及入住过急诊室OR及OR95%CI:3.57(1.67~7.62)]。鲍曼不动杆菌(AB)血流感染患者28 d生存率CRAB为66.17%,而CSAB为96.95%,CRAB组患者的生存率低于CSAB组(χ2=15.71,P0.001)。影响AB血流感染预后的独立危险因素包括感染CRAB(HR95%CI:3.01~67.28)、血液病(HR95%CI:3.77~25.97)、心功能不全(HR95%CI:2.10~20.41)、入住ICU(HR95%CI:1.01~5.28)及年龄(HR95%CI:1.01~1.04)。结论感染前入住ICU以及入住过急诊室是CRAB血流感染的危险因素,CRAB血流感染是影响患者预后的危险因素。

Risk factors and prognosis of patients with bloodstream infection due to carbapenem resistant Acinetobacter baumannii

ObjectiveTo explore the risk factors and prognosis of hospitalized patients with bloodstream infection due to carbapenem resistant Acinetobacter baumannii(CRAB).Methods163 patients with CRAB bloodstream infection from 2010 to 2013 were conducted retrospective case control study, 68 patients with bloodstream infection due to carbapenem susceptible Acinetobacter baumannii(CSAB) during the same period were as control group.ResultsThe independent risk factors for CRAB bloodstream infection were stay in intensive care unit(ICU) (OR,1.27［95%CI,5.55-22.89］) and emergency department(OR,3.57 ［95%CI,1.67-7.62］) before infection. Patients with CRAB bloodstream infection had lower 28 day survival rate than those with CSAB bloodstream infection(66.17% vs 96.95%，χ2=15.71,P＜0.001). The independent risk factors for influencing prognosis of Acinetobacter baumannii bloodstream infection were infection of CRAB (HR 95% CI,3.01-67.28), blood disease(HR 95%CI, 3.77-25.97), cardiac insufficiency(HR 95%CI,2.10-20.41), stay in ICU(HR 95%CI, 1.01-5.28),and age(HR 95%CI,1.01-1.04).ConclusionThe independent risk factors for CRAB bloodstream infection are stay in ICU and emergency department before infection, CRAB bloodstream infection is risk factor for influencing prognosis of patients.