RICU医院获得性鲍曼不动杆菌肺炎49例临床分析

目的:了解我院呼吸科重症监护病房(Respiratory intensive careunit,RICU)医院获得性鲍曼不动杆菌肺炎(Acinetobacterbaumannii hospital-acquired pneumonia,ABHAP)的发病情况、耐药性特点以及危险因素,探讨预防和治疗ABHAP的措施.方法:收集我院RICU在2007年5月至2008年10月期间发生的医院获得性肺炎(Hospital-acquired pneumonia,HAP)患者的临床资料以及药敏试验结果,回顾性分析ABHAP的发病情况、耐药性特点以及相关危险因素.结果:共发生HAP159例,其中ABHAP49例,占全部HAP的30.8%,鲍曼不动杆菌是HAP的第二位常见病原菌,对常用三代头孢菌素和三代氟喹诺酮类抗菌药物耐药率均大于90%,对亚胺培南的耐药率为42.7%,全耐药率为23.5%.单因素分析发现:APACHEII评分≥20、RICU内住院时间t≥2周、有创机械通气、有创机械通气≥7 d、气管插管或气管切开、气管插管或气管切开≥7d以及使用广谱抗生素≥7 d与发生ABHAP有关.多因素Lgistic回归分析确立了4项独立危险因素:RICU内住院时间≥2周(OR=5.334)、有创机械通气时间≥7d(OR=7.561)、APACHEII评分≥20分(OR=2.962),以及使用广谱抗生素≥7d(OR=3.509).结论:RICU内ABHAP发生率高,耐药性强,治疗困难;缩短ICU住院时间,缩短有创机械通气时间,合理使用抗生素有利于预防和治疗ABHAP.

Hospital-acquired pneumonia due to acinetobacter baumannii in RICU- a report of 49 cases

Objective: To investigate the prevalence, antibiotic resistance and risk factors of Acinetobacter Baumannii hospital-acquired pneumonia (ABHAP) in Respiratory Intensive Care Unit (RICU) of our hospital for guidance of clinical prevention and treatment of ABHAP. Methods: Clinical information and results of Antibiotic susceptibility test for all of the patients with hospital-acquired pneumonia (HAP) in RICU of our hospital from May 2007 to October 2008 were collected. Antibiotic resistance and risk factors of ABHAP were analyzed retrospectively. Results: 159 patients suffered from HAP. Of which, 49 patients had ABHAP and accounted for 30.8% of all cases. Acinetobacter Baumannii was the second commonest pathogen of HAP. The resistance rate of Acinetobacter Baumannii strains to the third generation of Cephalosporin and Fluoroquinolone were over 90%. And the resistance rate to Imipenen was 42.7%. Pan-resistant rate was 23.5%. Univariate analysis showed that APACHEII score≥20, hospitalization in RICU ≥2 weeks,invasive mechanical ventilation, invasive mechanical ventilation ≥7 days, trachea intubation or tracheotomy, trachea intubation or tracheotomy ≥7 days and broad-spectrum antibiotic therapy ≥7 days were associated with BAHAP. Multivariate logistic analysis showed that hospital ization in RICU ≥2 weeks,invasive mechanical ventilation ≥7 days, APACHEII score ≥20 and broad-spectrum antibiotic therapy ≥7 days were independent risk factors of ABHAP. Conclusions: The present study found high incidence rate, severe drug-resistance and therapeutic difficulties of ABHAP in RICU. Shortening duration of hospitalization and invasive mechanical ventilation, rational use of antibiotics are helpful to prevent and treat ABHAP.