摘要
目的探讨重症医学科(ICU)下呼吸道鲍曼不动杆菌(AB)感染诊断及治疗的方法,为AB防治提供参考依据。方法收集2017年9月—2018年8月某三甲医院综合ICU微生物学培养标本中检出AB患者的临床资料,就AB检出情况、药敏结果,以及AB下呼吸道定植、感染诊疗情况进行回顾性分析,比较AB下呼吸道感染患者采取抗AB感染治疗(治疗组)与未采取抗AB感染治疗(对照组)的疗效。结果共检出AB 106株,定植占51.89%(55株),医院感染占43.40%(46株),检出部位以下呼吸道为主,占92.45%(98株)。AB对15种抗菌药物的敏感率均低于30%,对多粘菌素及替加环素的敏感率较高,分别为96.23%、66.98%。下呼吸道AB定植和感染患者痰涂片白细胞/鳞状上皮细胞、痰培养生长状况、肺炎症状体征、感染指标及肺部影像学比较,差异均具有统计学意义(均P<0.05)。47例下呼吸道AB感染患者中,治疗总有效率治疗组为88.00%,对照组为81.82%,两组患者治疗效果比较差异无统计学意义(P>0.05)。结论综合ICU AB主要来自下呼吸道,多为定植菌,感染以医院感染为主,仅对多粘菌素及替加环素较敏感。下呼吸道AB痰涂片、痰培养生长状况、肺炎症状体征、感染指标及肺部影像学有助于判断感染或定植,其感染患者中治疗组的临床疗效并不优于对照组。
Objective To investigate the diagnosis and treatment of Acinetobacter baumannii(AB)lower respiratory tract infection(LRTI)in intensive care unit(ICU),and provide reference for the prevention and treatment.Methods Clinical data of patients who were isolated AB in a general ICU of a tertiary first class hospital from September 2017 to August 2018 were collected,isolation of AB,antimicrobial susceptibility testing results,colonization of AB in lower respiratory tract(LRT),as well as diagnosis and treatment were retrospectively analyzed,efficacy of anti-AB infection treatment(treatment group)and non-anti-AB infection treatment(control group)in patients with AB LRTI were compared.Results A total of 106 strains of AB were isolated,51.89%(55 strains)were colonized strains,healthcare-associated strains accounted for 43.40%(46 strains),92.45%(98 strains)were isolated from LRT.Susceptibility rates of AB to 15 kinds of antimictrobial agents were all lower than 30%,susceptibility rates to polymyxin and tigecycline were 96.23%and 66.98%respectively.There were significant differences in white blood cell(WBC)/squamous cell,sputum culture,symptoms and signs of pneumonia,infection indicators and lung imaging between patients with AB colonization and LRTI(all P<0.05).Of 47 patients with AB LRTI,the total therapeutic effective rates were 88.00%in treatment group and 81.82%in control group,there was no significant difference in therapeutic efficacy between two groups of patients(P>0.05).Conclusion AB in general ICU mainly comes from LRT,most are colonized bacteria and can cause healthcare-associated infection,and only susceptible to polymyxin and tigecycline.LRT AB sputum smear,sputum culture,symptoms and signs of pneumonia,infection indicators and lung imaging are helpful to determine infection or colonization,clinical efficacy of treatment group is no better than that of control group.
作者
熊自超
陈锦峰
罗锋
匡智明
朱建龙
刘秋妹
邹淑慧
XIONG Zi-chao;CHEN Jin-feng;LUO Feng;KUANG Zhi-ming;ZHU Jian-long;LIU Qiu-mei;ZOU Su-hui(Department of Healthcare-associated Infection Management,Ganzhou People’s Hospital,Ganzhou 341000,China;Intensive Care Unit,Ganzhou People’s Hospital,Ganzhou 341000,China;Department of Laboratory Medicine,Ganzhou People’s Hospital,Ganzhou 341000,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2020年第8期721-727,共7页
Chinese Journal of Infection Control
基金
赣州市人民医院青年人才科研扶持项目(20181211)。
关键词
重症医学科
鲍曼不动杆菌
下呼吸道
医院感染
社区感染
intensive care unit
Acinetobacter baumannii
lower respiratory tract
healthcare-associated infection
community-associated infection
