耐碳青霉烯类鲍氏不动杆菌医院获得性肺炎危险因素分析  

Risk factors of hospital-acquired pneumonia caused by carbapenem-resistant acinetobacter baumannii

作　　者：王玲[1] 杨连松[1] 王清华[1] 王剑利[1] 

机构地区：[1]北京市普仁医院呼吸科,北京100062

出　　处：《中华医院感染学杂志》2011年第14期2954-2956,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨耐碳青霉烯类鲍氏不动杆菌(CRAB)医院获得性肺炎的危险因素。方法采用病例对照研究,收集2005年1月-2010年12月鲍氏不动杆菌(ABA)引起的医院获得性肺炎92例,分为CRAB医院获得性肺炎组30例和碳青霉烯类敏感鲍氏不动杆菌(CSAB)医院获得性肺炎组62例;采用单因素分析及多因素logistic回归分析。结果单因素分析发现,APACHEⅡ评分≥16分、气管插管或气管切开、机械通气、分离出ABA前<2周曾应用过亚胺培南或美罗培南、≥2种抗菌药物联合应用与CRAB感染有关;多因素logistic回归分析发现,APACHEⅡ≥16分(OR=4.144,95%Cl1.346～12.761,P=0.013)及分离出CRAB前<2周曾应用过亚胺培南或美罗培南(OR=3.236,95%Cl1.128～9.282,P=0.029)是独立危险因素;CRAB组死亡11例,CSAB组死亡19例,2组死亡率差异无统计学意义。结论 APACHEⅡ≥16分及分离出CRAB前<2周曾应用过亚胺培南或美罗培南,是CRAB医院获得性肺炎的独立危险因素。OBJECTIVE To study the risk factors of hospital acquired pneumonia （HAP） caused by carbapenem- resistant Acinetobacter baumannii （CRAB）. METHODS A retrospective case control study was conducted for the patients who had HAP caused by A. baumannii （ABA） between Jan 2005 and Dec 2010. There were 30 cases of HAP caused by CRAb and 62 cases of HAP caused by CSAB （carbapenem-senstive A. baumannii）. Univariate analysis （T test and chi-square test） and multivariate logistic regression were used for statistics analysis. RESULTS Univariate analysis revealed that five factors were associated with the infection caused by CRAB, which were APACHE Ⅱ score ≥16, imipenem/meropenem used less than 2 weeks before isolation of CRAB, and combination therapy of antibiotics, invasive mechanical ventilation, endotracheal intubation/tracheotomy. Multivariate logistic regression analysis identified two independent factors, which were APACHEII score ≥16 （OR= 4. 144） and imipenem/meropenem used less than 2 weeks before isolation of CRAB （OR=3. 236）. CONCLUSION APACHE II score ≥16 and imipenem/meropenem used less than 2 weeks before the isolation of CRAB are the independent risk factors for CRAB infection.

关 键 词：鲍氏不动杆菌 医院获得性肺炎 耐碳青霉烯类 危险因素 

分 类 号：R181.32[医药卫生—流行病学]