摘要
目的调查儿童重症监护病房（PICU）多重耐药鲍氏不动杆菌（MI）RAb）肺部感染危险因素及药物敏感性，为减少MDRAb感染发生及有效治疗提供帮助。方法以45例非MDRAb肺部感染患儿（NMDRAb组）为对照，回顾性分析2009年1月至2011年8月武汉市儿童医院PICU收治的115例MDRAb肺部感染（MDRAb组）药敏结果，采用单因素和多因素Logistic回归分析方法，分析各研究因素与MDRAb感染关系，找出感染危险因素。结果共检出Ab176株，其中MDRAb128株，占72．73％。药敏结果显示，除头孢哌酮／舒巴坦外，其他B呐酰胺类药物耐药率均〉70％，碳青霉烯类药物耐药率高达90％以上，普遍高于NMDRAb感染组，阿米卡星、环丙沙星、左旋氧氟沙星及米诺环素耐药率最低（〈20％）；多因素Logistic回归分析显示ICU入住时间、机械通气时间、贫血、低蛋白血症、前期碳青霉烯类抗生素的使用为MDRAb肺部感染独立危险因素。结论MDRAb是PICU肺部感染的重要条件致病菌，耐药现象严重，严重影响患儿预后，针对感染相关危险因素，积极采取行之有效的预防措施是降低其发生率的关键。
Objective To investigate the risk factors involved in the refractory pneumonia caused by muhidrug resistant acinetobacter baumannii （MDRAb） in pediatric Intensive care unit （PICU）. Methods From January 2009 to August 2011, 115 patients with MDRAb pneumonia were treated in Department of Emergency, Wuhan Children Hospital, Wuhan. Another 45 patients with negative MDRAb （NMDRAb） pneumonia served as control. The patients in the two goups were analyzed using univariate and muhivariate Logistic regression to find out the risk factors for MDRAb infection. Results Among the 176 clinical strains of acinetobacter baumannii isolated, 128 （72.73%） strains were MDRAb. After drug susceptibility tests, acinetobacter baumannii showed the rates of resistance to β-1actams antibiotics not including cefoperazone- sulbactam were more than 70%, and the rates of resistance to carbapenems antibiotics were higher than 90%. All rates of resistance to antibiotics of betalactams and carbapenems in MDRAb were higher than those in NMDRAb significantly. There were very low rates of drug-resistance found in Amikacin, Levofloxacin, Ciprofloxacin and Minocycline （ 〈 20% ）. Multivariate logistic regression revealed that ICU stay, length of time for mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors involved in MDRAb pneumonia. Conclusions MDRAb was an important conditional pathogen with high rate of drug-resistance to many antibiotics leading to pneumonia in PICU. It increased the mortality of patients significantly. To control the infection of MDRAb was the key to increasing efficacy of treatment of pneumonia in PCIU.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第4期356-360,共5页
Chinese Journal of Emergency Medicine
关键词
重症监护病房
儿童
多重耐药
鲍氏不动杆菌
肺炎
危险因素
回顾性分析
Pediatric
Intensive care unit
Multidrug resistant
Acinetobacter baumannii
Pneumonia
Risk factor
Retrospective study
