摘要
目的:探讨重症监护病房(ICU)多重耐药鲍曼不动杆菌(Ab)血流感染的临床特点。方法:回顾性分析2012年1月至2015年3月收集的83例Ab血流感染患者的临床特点、危险因素,细菌耐药及预后。结果:83例患者中男60例(72.29%),女23例(27.71%),年龄为(46.23±19.22)岁;混合感染20例(24.10%),基础疾病种类3种以上共60例(72.29%);52例纳入病原菌同源性统计,下呼吸道的比例最高(29例),其次为导管11例,创面分泌物8例,脑脊液3例,腹水1例;危险因素有各类导管插管、严重的原发疾病,糖皮质激素的使用,手术及侵袭性操作等。Ab耐药性极高,以多重耐药菌为主,部分全耐药,对除头孢哌酮/舒巴坦及阿米卡星外的其他抗生素耐药率均大于80%。本组患者好转25例(30.12%),死亡55例(66.26%),治愈3例(3.62%)。结论:Ab耐药率高,病死率高,预后极差;对基础疾病严重的患者,应缩短住院时间,控制呼吸机和免疫抑制剂的使用;侵入性操作需严格执行消毒,减少血流感染的风险;避免抗生素滥用以减缓细菌耐药性增长。
Objective:To analyze the clinical characteristics of patients with bloodstream Acinetobacter baumannii infection in Intensive Care Unit(ICU).Methods:Eighty-three ICU patients with bloodstream Acinetobacter baumannii infection from January 2012 to March 2015 were retrospectively analyzed,including infection-related risk factors,drug-resistant bacteria,treatments and prognosis.Results:Among 83 patients,60 patients(72.29%) were male,23(27.71%) were female.The youngest patient was 40 days old,the oldest was 92 years old,the age was(46.23±19.22) years old.In total,there were 20 patients(24.10%) with plural bacterial infection in blood,60(72.29%) with more than 3 kinds of disorders,52 patients suffered homologous bacterial infection in blood and other organs.Among these cases,lower respiratory tract had the highest percentage of homologous bacteria(29 cases),followed by catheter(11 cases),wound secretion(8 cases),cerebrospinal fluid(3 cases) and ascites(1 case).The risk factors of bloodstream infection by Acinetobacter baumannii included catheterization,serious primary disease and basic disease,usage of corticosteroids,surgery and invasive operation and so on.Acinetobacter baumannii were highly resistant.Most of them were multi-drug resistance,and some were pan-drug resistance.It showed more than 80%drug resistant rate to antibiotics except sulbactam,cefopcrazone and amikacin.Among 83 patients,55 cases(66.26%) were dead,25 cases(30.12%) were improved and 3 cases(3.62%) were cured.Conclusion:Acinetobacter baumannii are highly and multidrug-resistant to commonly used antibiotics.Patients in ICU suffering serious basic diseases should be shorten hospitalization time,restricted the use of breathing machine and immunosuppressant.It must carry out disinfection for invasive operation to reduce the risk of bloodstream infections,and the abuse of antibiotics must be avoided to slow bacteria resistance.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2015年第12期1327-1332,共6页
Journal of Central South University ：Medical Science
基金
国家自然科学基金(81200048
81470255)
湖南省自然科学基金(2015JJ4063)~~
关键词
重症监护病房
鲍曼不动杆菌
血流感染
耐药性
危险因素
Intensive Care Unit
Acinetobacter baumannii
bloodstream infection
drug resistance
risk factors
