摘要
目的 了解多重耐药鲍曼不动杆菌（MDRAB）感染的危险因素及预后情况.方法 采用病例对照比较鲍曼不动杆菌感染者中多重耐药株与敏感株之间相关暴露因素及药敏结果的差别;数据分析采用t检验、x2检验及多因素logistic回归.结果 MDRAB感染者以院内感染（58.76％）居多,常见感染部位为呼吸道（85.05％）;MDRAB感染者平均延长住院13.39 d,治疗费均增95 171.58元,其病死率及自动出院率总和增加31.96％.多因素logistic回归分析表明,基础疾病个数（OR=3.012,95％CI：1.153～7.868）、入住ICU（OR=2.935,95％CI：1.093～7.885）、病情的严重程度（OR=6.481,95％CI：2.524～16.644）、碳青酶烯类药物使用（OR=7.988,95％CI：2.961～21.547）和深静脉置管（OR=2.875,95％ CI：1.049～7.880）为MDRAB感染的独立危险因素.MDRAB的耐药情况严重,14种抗菌药物中9种药物的耐药率达100％,与敏感组的耐药率相比,差异有统计学意义（P＜0.05）.结论 MDRAB的耐药性严重,其感染者愈后和转归不佳;对入住ICU病情严重合并基础疾病多的患者,应强调抗菌药物尤其碳青酶烯类药物的合理使用,避免其引起的爆发流行.
We investigated risk factors and prognosis of multidrug-resistant Acinetobacter baumannii （MDRAB） infection to provide evidence for preventing and controlling the infection.By a case-control study,we analyzed the difference about risk factors and results of antimicrobial susceptibility test between the multidrug-resistant isolates and sensitive isolates in patients infected with Acinetobacter baumannii.The t-test,chi-square test and multivariate logistic regression were used for statistics analysis.Of 58.76％ patients with MDRAB belonged to nosocomial infection,and 85.05％ of them were infected through the respiratory tract.Compared with patients infected by sensitive isolates,those by MDRAB were higher in hospital stay duration （a average growth of 13.39 days）,the total cost of treatment （a average growth of ￥95 171.58）,and the rate of mortality and automatic discharge rate （a average growth of 31.96 ％）.Multivariate logistic regression analysis identified 5 independent factors as the number of underlying disease （OR：3.012,95％ CI：1.153 to 7.868）,ICU stay （OR：2.935,95％CI：1.093 to 7.885）,disease severity （OR：6.481,95％ CI：2.524 to 16.644）,carbapenem drug use （OR：7.988,95％ CI：2.961 to 21.547）,and deep venous catheter （OR：2.875,95％ Ch 1.049 to 7.880）.Differences of drug-resistant rates between case group and control group had statistical significance.Drug-resistant rates of case group were severe,in which 9 in 14 drugs were 100％ resistant.As the drug-resistant status of MDRAB was severe and the prognosis of patients infected by MDRAB was poor,patients should be under monitoring,especially those staying at ICU with severe diseases.To avoid the outbreak of MDRAB,we should take effective measures and emphasize the rational use of antimicrobial agents,especially the carbapenems.
出处
《中国人兽共患病学报》
CAS
CSCD
北大核心
2014年第11期1097-1102,共6页
Chinese Journal of Zoonoses
关键词
鲍曼不动杆菌
多重耐药
危险因素
预后
Acinetobacter baumannii
multidrug resistance
risk factors
prognosis
