重症监护科鲍曼不动杆菌感染预后和耐药的关系

目的 研究重症监护科（ICU）患者鲍曼不动杆菌感染预后和菌株耐药情况的关系.方法 回顾性分析鲍曼不动杆菌感染患者84例,根据30 d预后情况分为存活组（59例）和死亡组（25例）,采用二分类logistic回归分析确立鲍曼不动杆菌耐药性对病死率的影响.结果 单因素分析提示年龄、血液系统恶性疾病、Charison基础疾病评分、APACHEII评分、多重耐药鲍曼不动杆菌（MDRAB）、耐碳青酶烯鲍曼不动杆菌（CRAB）、感染性休克和抗菌药物不恰当治疗与鲍曼不动杆菌感染死亡有关（P＜0.05）.二分类logistic回归分析显示CRAB和Charison基础疾病评分是鲍曼不动杆菌感染死亡的独立危险因素（P＜0.05）,其OR值分别是3.360（95%CI：1.563～7.223）和1.633（95%CI：1.201～2.221）.结论 鲍曼不动杆菌感染预后与菌株的耐药性密切相关,CRAB明显增加鲍曼不动杆菌感染的死亡风险.

The prognosis of acinetobacter baumannii infection associated with drug resistance in the intensive care unit

Objective To research the association between the prognosis of Acinetobacter baumannii infection and drug resistance among patients in the intensive care unit( ICU). Methods Eighty-four patients with Acine tobacter baumannii infection from February 2003 to April 2009 in Peking University Shenzhen Hospital ICU were retrospectively analyzed and divided into alive group(59 patients) and dead group(25 patients) by using 30-day mortality. The impact of drug resistant Acinetobacter baumannii on mortality was assessed by binary logistic regression. Results The mortality of patients with Acinetobacter baumannii infection was related to age, haematological malignancy, the Chanson Comorbidity Index, APACHEII score, multidrug-resistant Acinetobacter baumannii ( MDRAB) , carbapenem-resistant Acinetobacter baumannii (CRAB ) , septic shock and antimicrobial inappropriate therapy by univariate analysis( P < 0.05). Binary logistic regression revealed that CRAB( OR = 3. 360,95%CI: 1. 563 ～7.223,P< 0.05)and the Charison Comorbidity Index( OR = 1. 633,95% CI: 1. 201 ～2. 221 ,P <0.05) were independent risk factors. Conclusions The prognosis of Acinetobacter baumannii infection was closely correlated with drug resistance. The patients with CRAB infection had a higher mortality.