ICU重症患者下呼吸道鲍氏不动杆菌感染的危险因素及耐药性

目的探讨重症监护室(ICU)重症患者发生下呼吸道鲍氏不动杆菌感染的危险因素及耐药状况,为临床防治提供参考。方法选取2018年1月-12月于郑州大学附属洛阳中心医院ICU住院期间发生下呼吸道感染的重症患者82例,采集患者下呼吸道标本进行病原菌培养、鉴定和药敏试验,收集患者临床资料,单因素及多因素Logistic回归分析发生下呼吸道鲍氏不动杆菌感染的危险因素。结果 82例患者均检出病原菌,共检出感染病原菌89株,其中革兰阴性菌56株、革兰阳性菌30株、真菌3株,分别占62.92%、33.71%、3.37%。22例患者为鲍氏不动杆菌感染,占26.83%,多因素Logistic回归分析显示患者APACHEⅡ评分≥15分、GCS评分<8分、气管切开/插管、机械通气、留置胃管、使用糖皮质激素是患者发生下呼吸道鲍氏不动杆菌感染独立危险因素(P<0.05);检出的鲍氏不动杆菌对头孢曲松钠完全耐药,对头孢他啶、氨曲南、美罗培南、亚胺培南、庆大霉素、哌拉西林/他唑巴坦、氨苄西林/舒巴坦的耐药率≥50.00%,对头孢哌酮/舒巴坦、阿米卡星、左氧氟沙星、替加环素的耐药率相对较低。结论 ICU重症患者并发下呼吸道感染时鲍氏不动杆菌检出率较高,对抗菌药物耐药性较高,APACHEⅡ评分≥15分、GCS评分<8分、气管切开/插管、机械通气、留置胃管、使用糖皮质激素是引起患者发生下呼吸道鲍氏不动杆菌感染的独立危险因素。

Risk factors for lower respiratory tract Acinetobacter baumannii infection in critically ill patients of ICU and drug resistance

OBJECTIVE To explore the risk factors for lower respiratory tract Acinetobacter baumannii infection in critically ill patients of intensive care unit(ICU)and observe the drug resistance so as to provide guidance for clinical prevention and treatment.METHODS From Jan 2018 to Dec 2018,a total of 82 critically ill patients who had lower respiratory tract infection during the stay in ICU of Luoyang Central Hospital Affiliated to Zhengzhou University were enrolled in the study,the lower respiratory tract specimens were collected to conduct the culture of pathogens,the isolated pathogens were identified,the drug susceptibility testing was performed,the clinical data were collected,and the univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the lower respiratory tract infection with A.baumannii.RESULTS All of the 82 patients were detected with pathogens;totally 89 strains of pathogens were isolated,56(62.92%)of which were gram-negative bacteria,30(33.71%)were gram-positive bacteria,and 3(3.37%)were fungi.Totally 22 patients had A.baumannii infection,accounting for 26.83%.The multivariate logistic regression analysis showed that APACHEⅡscore no less than 15 points,GCS score less than 8 points,tracheotomy,endotracheal intonation,mechanical ventilation,gastric tube indwelling and use of glucocorticoids were the independent risk factors for the lower respiratory tract A.baumannii infection(P<0.05).All of the isolated A.baumannii strains were resistant to ceftriaxone sodium,and the drug resistance rates of the strains to ceftazidime,aztreonam,meropenem,imipenem,gentamicin,piperacillin-tazobactam and ampicillin-sulbactam were no less than 50.00%,while the drug resistance rates to cefoperazone-sulbactam,amikacin,levofloxacin and tigecycline were relatively low.CONCLUSION The isolation rate of A.baumannii strains is high among the critically ill ICU patients complicated with postoperative urinary tract infection,the strains are highly drug-resistant.APACHEⅡscore no less than 15 points,GCS score less than 8 points,tracheotomy,endotracheal intonation,mechanical ventilation,gastric tube indwelling and use of glucocorticoids are the independent risk factors for the lower respiratory tract A.baumannii infection.