重症肺炎中泛耐药鲍曼不动杆菌的感染危险因素及耐药性分析

目的 评估重症肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素并对其耐药性进行分析,为防治鲍曼不动杆菌感染提供临床依据.方法 收集广西医科大学第一附属医院2012年6月至2014年12月收治的156例重症肺炎患者的临床资料,筛选出痰检为鲍曼不动杆菌感染患者共44例,采取单因素分析及多因素回归分析,分析重症肺炎中泛耐药鲍曼不动杆菌感染(XDRAB)的危险因素,及对18种常用抗菌药物的耐药情况,并对病死率进行比较.结果 多因素回归分析发现:人院1周内使用碳青霉烯类抗生素、合并三种以上基础疾病、入院时急性生理与慢性健康状况(APACHEⅡ)评分≥20分、使用三种以上抗生素是XDRAB感染的独立危险因素.XDRAB仅对头孢哌酮舒巴坦、米诺环素、替加环素耐药率较低(分别为20.8％、33.3％、12.5％),对其他15种抗菌药物耐药率均＞50％,对亚胺培南耐药率高达79.2％,美洛培南耐药率高达83.3％.XDRAB组患者病死率明显增加.结论 入院1周内使用碳青霉烯类抗生素、合并三种以上基础疾病、使用三种以上抗生素、入院时APACHEⅡ评分≥20分是重症肺炎中XDRAB感染的独立危险因素.XDRAB耐药情况严重,仅对头孢哌酮舒巴坦、替加环素、米诺环素耐药率相对较低,患者预后差,病死率高.

Clinical analysis of the infection related factors and drug resistance of severe pneumonia caused by extensively drug resistance of Acinetobacter Baumannii

Objective To evaluate the related factors and drug resistance of severe pneumonia caused by extensively drug resistance of Acinetobacter Baumannii,to provide reasonable evidence for Acinetobacter Baumannii prevention and improve survival rate of patients with severe pneumonia.Methods A retrospectively analysis was carried out of clinical data on 156 cases of severe pneumonia treated from June,2012 to December,2014 in the First Affiliated Hospital of Guangxi Medical University.Screened 44 patients with Acinetobacter Baumannii infection in sputum examination,all of them were drug-resistant strains.Of these drug-resistant strains,extensively drug resistant Acinetobacter Baumannii was found in 24 cases,multi-drug resistant Acinetobacter Baumannii was found in 20 cases,the methods of single factor analysis and multifactor logistic regression analysis were used between the 2 groups,to analyze the risk factors of severe pneumonia caused by the extensively drug resistant Acinetobacter Baumannii,at the same time,to analyze the status of drug-resistance to 18 commonly used antibiotics of the extensively drug resistant Acinetobacter Baumannii,compared death rate of the patients between 2 groups.Results The single factor analysis:within 24 hours of admission in ICU,hospital time,tracheal intubation/ tracheotomy,3 or more than 3 kinds of antibiotics to be used in combination,using carbapenem antibiotics within 1 week on admission,using mechanical ventilation more than 5 days,with 3 basic diseases at the same time,the acute physiology and chronic health evaluation (APACHE) Ⅱ score ≥20 scores on admission,etc,all the factors above were significantly related to extensively drug resistant Acinetobacter Baumannii (XDRAB) in sever pneumonia.The multifactor logistic regression analysis:using carbapenem antibiotics within 1 week of admission,using more than 3 kinds of antibiotics in combination,with 3 basic diseases at the same time,the APACHE Ⅱ score ≥20 scores on admission,these were the independent risk factors for XDRAB in sever pneumonia.XDRAB had low resistance rate only to cefoperazone sulbactam,mynocycline and tigecycline(which had ratios of 20.8 ％,33.3 ％ and 12.5 ％,respectively),but to the other 15 kinds of antibiotics,the drug resistance rate were higher,especially to yaan imipenem and meropenem,which had ratios of 79.2 ％ and 83.3 ％,respectively.Compared with MDRAB,the resistance rate of XDRAB were noticeably rising to the most of antibiotics,patients' death rate of the XDRAB group were also noticeably rising.Conclusions Compared with MDRAB,the hospital stay and mechanical ventilation time are prolonged in XDRAB group,patientsdeath rate of the XDRAB group are noticeably rising and cases of admission in ICU within 24 hours are also markedly increased.Using carbapenem antibiotics within 1 week of admission,with 3 basic diseases at the same time,using more than 3 kinds of antibiotics in combination,the APACHE Ⅱ score ≥20 scores on admission,these are the independent risk factors for XDRAB in sever pneumonia.The status of drug-resistance of XDRAB is bad.XDRAB has low resistance rate only to cefoperazone sulbactam,mynocycline and tigecycline.The patients show extremely poor prognosis,high mortality.