摘要
目的探讨碳青霉烯类药物暴露对鲍曼不动杆菌(AB)感染多重耐药及预后的影响。方法回顾性分析2016年4月至2018年4月惠州市第一人民医院确诊的120例院内感染者的临床资料,依据碳青霉烯类抗菌药物暴露情况分为两组,即碳青霉烯类抗菌药物暴露组(59例)和非碳青霉烯类抗菌药物暴露组(61例),比较两组患者AB感染、多重耐药鲍曼不动杆菌(MDRAB)检出率,分析耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率和耐药率;Logistic回归模型分析影响AB感染者预后的危险因素。结果碳青霉烯类抗菌药物暴露组患者AB感染率、MDRAB检出率均显著高于非碳青霉烯类抗菌药物暴露组,差异均有统计学意义(79.66%vs.19.67%,χ^2AB=43.184、P<0.001;71.19%vs.3.28%,χ^2MDRAB=59.558、P<0.001)。检出CRAB共92株,其中2017年至2018年CRAB检出率较2016年至2017年增长87.50%。92株CRAB对头孢类、碳青霉烯类、哌拉西林、哌拉西林/他唑巴坦、庆大霉素、磷霉素等均有不同程度耐药,仅对阿米卡星和环丙沙星敏感。碳青霉烯类抗菌药物暴露组病死率显著高于非碳青霉烯类抗菌药物暴露组,差异有统计学意义(42.37%vs.9.84%,χ^2=16.572、P<0.001)。单因素分析显示:AB感染者预后不良与入住ICU时间(χ^2=8.563、P=0.003)、机械通气(χ^2=10.898、P=0.001)、留置尿管(χ^2=12.725、P<0.001)、留置中心静脉置管(χ^2=6.306、P=0.012)、头孢类药物使用(χ^2=25.095、P<0.001)、碳青霉烯类药物暴露(χ^2=33.005、P<0.001)以及联合抗菌药物应用(χ^2=8.241、P=0.004)均相关,差异均具有统计学意义。Logistic分析显示:碳青霉烯类药物暴露与AB感染者预后独立相关(OR=10.687、95%CI:0.025~0.937、P<0.001)。结论碳青霉烯类抗菌药物暴露可增加AB感染机率,导致多重耐药,为AB感染者预后不良的独立危险因素。
Objective To investigate the effect of carbapenems exposure on multiple drug resistance and prognosis of Acinetobacter baumannii(AB)infection.Methods The clinical data of 120 patients with confrmed as nosocomial infection from April 2016 to April 2018 in Huizhou First People’s Hospital were analyzed,retrospectively.According to the exposure of carbapenems or not,the 120 patients were divided into two groups:carbapenems exposure group(59 cases)and non-carbapenems exposure group(61 cases).The detection rates of AB infection and multidrug-resistant Acinetobacter baumannii(MDRAB)of the two groups were compared.The rate of detection and drug resistance of carbapenems resistant Acinetobacter baumannii(CRAB)were analyzed,respectively.Logistic regression model was used to analyze the risk factors influencing the prognosis of patients with AB infection.Results Carbapenems exposure group had higher rate of AB infection and detection rate of MDRAB than those of non-carbapenems exposure group,with signifcant differences(79.66% vs 19.67% ,χ^2AB=43.184,P<0.001;71.19% vs 3.28% ,χ^2MDRAB=59.558,P<0.001).A total of 92 strains of CRAB were detected,and the detection rate of CRAB in 2017-2018 increased by 87.50% compared with that of 2016-2017.All 92 strains of CRAB were resistant to cephalosporins,carbapenems,piperaxelin,piperaxillin/tazobartan,gentamycin and fosfomycin with different degrees,but only sensitive to amikacin and ciprofloxacin.The mortality rate of patients in carbapenems exposure group was higher than that of non-carbapenems exposure group(42.37% vs 9.84% ,χ^2=16.572,P<0.001).Single factor analysis showed that poor prognosis of patients with AB infection was related to hospitalization stay in ICU(χ^2=8.563,P=0.003),mechanical ventilation(χ^2=10.898,P=0.001),indwelling urinary catheter(χ^2=12.725,P<0.001),indwelling central venous catheter(χ^2=6.306,P=0.012),using cephalosporin(χ^2=25.095,P<0.001),carbapenems exposure(χ^2=33.005,P<0.001)and combined antibiotic application(χ^2=8.241,P=0.004),all with signi
作者
谢海雄
张韵
Xie Haixiong;Zhang Yun(Department of Pharmacy,Huizhou First People’s Hospital,Huizhou 516003,China;Department of Internal Medicine,Huizhou First People’s Hospital,Huizhou 516003,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2019年第2期140-145,共6页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
关键词
碳青霉烯类
鲍曼不动杆菌
多重耐药
预后
Carbapenems
Acinetobacter baumannii
Multidrug resistance
Prognosis
