摘要
目的评估重症肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素并对其耐药性进行分析，为防治鲍曼不动杆菌感染提供临床依据。方法收集广西医科大学第一附属医院2012年6月至2014年12月收治的156例重症肺炎患者的临床资料，筛选出痰检为鲍曼不动杆菌感染患者共44例，采取单因素分析及多因素回归分析，分析重症肺炎中泛耐药鲍曼不动杆菌感染（xDRAB）的危险因素，及对18种常用抗菌药物的耐药情况，并对病死率进行比较。结果多因素回归分析发现：入院1周内使用碳青霉烯类抗生素、合并三种以上基础疾病、入院时急性生理与慢性健康状况（APACHEⅡ）评分≥20分、使用三种以上抗生素是xDRAB感染的独立危险因素。xDRAB仅对头孢哌酮舒巴坦、米诺环素、替加环素耐药率较低（分别为20．8％、33．3％、12．5％），对其他15种抗菌药物耐药率均〉50％，对亚胺培南耐药率高达79．2％，美洛培南耐药率高达83．3％。XDRAB组患者病死率明显增加。结论入院1周内使用碳青霉烯类抗生素、合并三种以上基础疾病、使用三种以上抗生素、入院时APACHEⅡ评分≥20分是重症肺炎中XDRAB感染的独立危险因素。XDRAB耐药情况严重，仅对头孢哌酮舒巴坦、替加环素、米诺环素耐药率相对较低，患者预后差，病死率高。
Objective To evaluate the related factors and drug resistance of severe pneumonia caused by extensively drug resistance of Acinetobacter Baumannii, to provide reasonable evidence for Acinetobacter Baumannii prevention and improve survival rate of patients with severe pneumonia. Methods A retrospectively analysis was carried out of clinical data on 156 cases of severe pneumonia treated from June, 2012 to December, 2014 in the First Affiliated Hospital of Guangxi Medical University. Screened 44 patients with Acinetobacter Baumannii infection in sputum examination, all of them were drug-resistant strains. Of these drug-resistant strains, extensively drug resistant Acinetobacter Baumannii was found in 24 cases, multi-drug resistant Acinetobacter Baumannii was found in 20 cases, the methods of single factor analysis and multifactor logistic regression analysis were used between the 2 groups, to analyze the risk factors of severe pneumonia caused by the extensively drug resistant Acinetobacter Baumannii, at the same time, to analyze the status of drug-resistance to 18 commonly used antibiotics of the extensively drug resistant Acinetobacter Baumannii, compared death rate of the patients between 2 groups. Results The single factor analysis： within 24 hours of admission in ICU, hospital time, tracheal intubation/ tracheotomy, 3 or more than 3 kinds of antibiotics to be used in combination, using carbapenem antibiotics within 1 week on admission, using mechanical ventilation more than 5 days, with 3 basic diseases at the same time, the acute physiology and chronic health evaluation （APACHE） Ⅱ score ≥20 scores on admission, etc, all the factors above were significantly related to extensively drug resistant Acinetobacter Baumannii （XDRAB） in sever pneumonia. The multifactor logistic regression analysis：using carbapenem antibiotics within 1 week of admission, using more than 3 kinds of antibiotics in combination, with 3 basic diseases at the same time, the APACHE Ⅱ score ≥20 scores on admission, these we
出处
《国际呼吸杂志》
2016年第20期1543-1547,共5页
International Journal of Respiration
关键词
鲍曼不动杆菌
重症肺炎
危险因素
耐药性分析
Acinetobacter baumannii
Severe pneumonia
Related factor
Risk factor
Analysis of drug resistance
