重症监护室泛耐药鲍曼不动杆菌肺炎的危险因素分析

目的探讨ICU泛耐药鲍曼不动杆菌肺炎患者的危险因素，为临床区分感染与定植提供参考和依据。方法回顾性调查广东省中医院芳村医院2009年2月～2012年3月重症监护室（ICU）鲍曼不动杆菌肺炎患者99例，对引起泛耐药发生的相关因素进行多因素Logistic回归分析。结果入住ICU时间，有创通气时间，使用碳青霉烯类、β内酰胺类-β内酰胺酶抑制剂合剂、喹诺酮类抗菌药物的时间，使用抗菌药物3种以上，进行3种以上侵袭性操作（包括留置胃管、导尿管、深静脉管、动脉导管），纤维支气管镜治疗与泛耐药鲍曼不动杆菌感染有关（P〈0．05）。Logistic回归分析发现，抗菌药物种类数目、纤维支气管镜治疗及p内酰胺类-β内酰胺酶抑制刹合剂使用天数为独立危险因素。结论临床治疗时，应结合危险因素，区分感染还是定植，以采取相应防治措施。

The risk factor profile of pneumonia caused by pandrug-resistant Acinetobacter baumannii in intensive care unit

Objective To investigate the risk factor profile of pneumonia caused by pandrug resistant Acinetobacter baumannii （PDRAB） in intensive care unit for better distinction between PDRAB infection and colonization. Methods The clinical data of 99 patients diagnosed as A. baumannii pneumonia between February 2009 and March 2012 in Fangcun Hospital, a branch of Guangdong Provincial Hospital of Traditional Chinese Medicine, were reviewed and analyzed retrospectively. The risk factors associated with pandrug resistance in A. baumannii were examined with multivariate logistic regression analysis. Results ]CU stay, duration of invasive ventilation, longer duration of treatment with carbapenems, beta lactam/beta-lactamase inhibitor, or quinolone antibiotics, use of ≥3 classes of antimicrobial agents, ≥3 invasive procedures （including indwelling gastric canal, catheterization, central venous catheter, arterial sheath）, and fiberoptic bronchoscopic treatment were associated with PDRAB pneumonia （P〈0.05）. Multivariate logistic regression analysis showed that use of ≥3 classes of antibiotics, fiberoptic bron choscopic treatment, and longer duration of treatment with beta-lactam/beta-lactamase inhibitor were independent risk factors predicting the emergence of PDRAB pneumonia. Conclusions We should pay more attention to these risk factors in clinical prac tice for better differentiation between PDRAB infection and colonization so that appropriate control measures can be taken pro- actively.