摘要
目的探讨多重耐药(MDR)鲍曼不动杆菌血流感染的危险因素及影响鲍曼不动杆菌血流感染30 d预后的危险因素。方法采用病例对照的研究方法,回顾性分析2013年1月-2014年12月中国医科大学附属第一医院MDR鲍曼不动杆菌血流感染49例,以同时期敏感鲍曼不动杆菌血流感染29例作为对照,应用单因素分析及多因素logistic回归分析探讨MDR鲍曼不动杆菌血流感染的危险因素。将78例鲍曼不动杆菌血流感染患者按血培养标本采集后30 d内预后分为存活组(38例)和非存活组(40例),应用上述方法分析影响鲍曼不动杆菌血流感染30 d预后的危险因素。结果单因素分析发现,MDR鲍曼不动杆菌血流感染的危险因素包括:感染前应用碳青霉烯类药物、应用喹诺酮类药物、应用2类以上抗菌药物、接受机械通气、留置鼻胃管、留置中心静脉导管、入住ICU等;再进行logistic多因素回归分析,结果显示入住ICU(OR=7.118)、感染前应用2类以上抗菌药物(OR=8.073)是MDR鲍曼不动杆菌血流感染的独立危险因素。预后单因素分析结果提示影响鲍曼不动杆菌血流感染30 d预后的危险因素包括:入住ICU、机械通气、血培养提示MDR鲍曼不动杆菌感染等,再进行logistic多因素回归分析发现,MDR鲍曼不动杆菌感染(OR=5.837)、机械通气(OR=4.926)是影响鲍曼不动杆菌血流感染30 d预后的独立危险因素。结论感染前入住ICU、应用2类以上抗菌药物是MDR鲍曼不动杆菌血流感染的独立危险因素;MDR鲍曼不动杆菌感染、机械通气是影响鲍曼不动杆菌血流感染30 d预后的独立危险因素。
Objective To investigate the risk factors of bloodstream infections caused by multiple drug resistant Acinetobacter baumannii （MDRAB） and those associated with 30-day clinical outcomes of MDRAB patients. Methods A case-control study was designed to retrospectively analyze 49 cases of MDRAB-related bloodstream infections treated in our hospital during the period from January 2013 to December 2014. Additional 29 cases of non-MDRAB bloodstream infections were included as control group. Univariate and multivariate logistic analysis were used to identify the risk factors of MDRAB bloodstream infections. The prognostic factors were analyzed similarly for all the 78 cases of bloodstream infections by comparing the relevant factors between survival group （38 cases） and non-survival group （40 cases） based on the survival status 30 days after collecting blood samples. Results Univariate analysis revealed that the risk factors for MDRAB bloodstream infection included use of carbapenems, quinolones, or at least 2 antibiotics, mechanical ventilation, nasogastric tube, indwelled central venous catheter, and ICU stay prior to infection. Subsequent multivariate logistic analysis showed that ICU stay （OR=7.118） and prior use of at least 2 antibiotics （0R=8.073） were independent risk factors for MDRAB bloodstream infection. Univariate analysis revealed that ICU stay, mechanical ventilation,and MDRAB in blood sample were the prognostic factors of 30-day survival. Multiple logistic regression analysis showed that MDRAB infection （OR=5.837） and mechanical ventilation （OR=4.926） were the independent risk factors predicting of 30- day patient death. Conclusions ICU stay and prior use of at least 2 antibiotics were independent risk factors for MDRABbloodstream infection. MDRAB infection and mechanical ventilation were the independent risk factors predicting 30-day patient death in MDRAB bloodstream infections.
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2017年第2期134-139,共6页
Chinese Journal of Infection and Chemotherapy
基金
辽宁省自然科学基金(2013021091)
关键词
鲍曼不动杆菌
多重耐药
血流感染
危险因素
预后因素
Acinetobacter baumannii
multidrug-resistant
bloodstream infection
risk factor
prognosis
