鲍曼不动杆菌导致呼吸机相关性肺炎的细菌耐药性及危险因素研究

目的探讨鲍曼不动杆菌导致呼吸机相关性肺炎（VAP）中鲍曼不动杆菌的耐药情况以及VAP发生的危险因素。方法选取入住综合ICU建立机械通气病人为研究对象，确诊为VAP且细菌培养鉴定为鲍曼不动杆菌感染病人30例为观察组，同期选取非VAP病人按1:1匹配选取30例作为对照组。分析鲍曼不动杆菌的耐药性以及VAP发生的危险因素。结果分离出的鲍曼不动杆菌对丁胺卡那霉素、哌拉西林/他唑巴坦耐药率相对较低，分别为53.3%、66.6%，对头孢唑啉、氨苄西林、氨曲南、呋喃妥因、头孢替坦耐药率超过90%，对亚胺培南耐药率高达80%，而对其他抗菌药物耐药率均在70%以上。单因素分析显示，病人住院时间、机械通气方式、机械通气时间、感染前使用3联以上抗菌药物、感染前使用碳青霉烯类抗菌药物以及是否进行肠内营养在观察组和对照组之间差异均有统计学意义（P < 0.01）。logistic回归分析显示，住院时间≥14 d、气管切开、机械通气时间≥5 d均为鲍曼不动杆菌VAP发生的独立危险因素（P < 0.05）。结论鲍曼不动杆菌所致VAP中分离出的鲍曼不动杆菌对抗菌药物存在较高耐药性，应合理选择抗菌药物并针对相关危险因素加强医院感染管理。

Study on the drug resistance of bacteria and risk factors of Acinetobacter baumannii caused ventilator-associated pneumonia

ObjectiveTo investigate the drug resistance of Acinetobacter baumannii caused ventilator-associated pneumonia(VAP), and risk factors of VAP.MethodsThe patients treated with mechanical ventilation from ICU were investigated.Thirty Acinetobacter baumannii infection patients and 30 patients without VAP were divided into the observation group and control group, respectively.The drug resistance of Acinetobacter baumannii and risk factors of VAP were analyzed.ResultsThe drug resistance rates of Acinetobacter baumannii isolated to amikacin, piperacillin/tazobactam were relatively low, which was 53.3% and 66.6%, respectively.The drug resistance rates of Acinetobacter baumannii to cefazoline, ampicillin, aztreonam, nitrofurantoin and cefotetan were more than 90%, the drug resistance rate of Acinetobacter baumannii to imipenem reached 80%, and the drug resistance rates of Acinetobacter baumannii to other antimicrobia resistance were greater than 70%.The results of univariate analysis showed that the differences of drug resistance in length of hospital stay, mechanical ventilation mode, mechanical ventilation duration, using more than 3 combination of antibiotics before infection, using carbapenems before infection and using enteral nutrition were statistically significant(P < 0.01).The results of logistic analysis showed that the hospitalization time≥14 days, tracheotomy and mechanical ventilation time≥5 days were the independent risk factors of the incidence of Acinetobacter baumannii caused VAP.ConclusionsThe drug-resistance of Acinetobacter baumannii isolated froun Acinetobacter baumannii caused VAP to antibacterial agents is higher.The antibiotics should be reasonably selected, and the management of nosocomial infection should be strengthened according to the related risk factors.