亚胺培南耐药鲍曼不动杆菌医院获得性肺炎的危险因素及耐药性分析  

Analysis of risk factors and drug resistance for hospital-acquired pneumonia caused by imipenem-resistant Acinetobacter baumannii

作　　者：汪群智[1,2] 周华[1] 周建英[1] 

机构地区：[1]浙江大学附属第一医院呼吸内科,浙江杭州310003 [2]金华广福医院呼吸内科,浙江金华321000

出　　处：《中国微生态学杂志》2013年第9期1053-1057,共5页Chinese Journal of Microecology

摘　　要：目的探讨浙江大学附属第一医院亚胺培南耐药鲍曼不动杆菌(IRAB)引起医院获得性肺炎(HAP)的危险因素及预后,并了解该院IRAB的耐药情况。方法回顾性分析该院2011年1月至2012年12月收治的201例鲍曼不动杆菌医院获得性肺炎患者的临床资料,其中IRAB组155例,亚胺培南敏感(ISAB)组46例,两组间采取单因素分析及多因素Logistic回归分析,分析IRAB HAP发生的危险因素,并分析IRAB对其他16种抗菌药物的耐药情况,比较两组患者30天病死率。结果单因素分析发现:入住ICU、昏迷、气管插管/切开、机械通气、留置胃管、糖皮质激素使用≥1周、2种及以上抗生素联用、分离出AB前28天内碳青霉烯类抗生素使用、低白蛋白血症、入院时APACHE II评分≥20分与IRAB HAP发生显著相关,多因素Logistic回归分析发现:分离出AB前28天内碳青霉烯类抗生素使用、入院时APACHE II评分≥20分是IRAB HAP发生的独立危险因素;而IRAB仅对阿米卡星耐药率较低(38.7%),对头孢哌酮舒巴坦耐药率高达64.5%,且对比ISAB,IRAB对大部分抗菌药物耐药率均明显上升,IRAB组患者死亡率明显上升。结论分离出AB前28天内碳青霉烯类抗生素使用、入院时APACHE II评分≥20分是IRAB HAP发生的危险因素,IRAB耐药情况极其严重,均为多重耐药菌株,IRAB HAP患者预后差,死亡率高。Objective To study the risk factors and prognosis of hospital-acquired pneumonia （HAP） caused by imipenem-resist- ant Acinetobacter baumannii （IRAB）, and the drug resistance of IRAB. Methods Retrospective analysis was performed on the clinical data of 201 cases of hospital-acquired pneumonia caused by Acinetobacter baumannii in our hospital from January 2011 to December 2012. The IRAB group consisted of 155 cases and the imipenem-seusitive Acinetobacter baumannii （ISAB） group consisted of 46 cases. Univari- ate analysis and multivariate logistic regression analysis were performed between the two groups in terms of the risk factors of imipenem-re- sistant Acinetobacter baumannii hospital-acquired pneumonia, and the resistance of IRAB to other 16 kinds of antimicrobial agents ; 30-day mortality of the two groups were compared. Results Univariate analysis showed that [CU stay, coma, endotracheal intubation/cut, me- chanical ventilation, indwelling stomach tube, the duration of glucocorticoid use 1〉 7 days, two and more antibiotics combination, previ- ous use of carbapenem within 28 days before isolation of AB, and APACHE II score on admission I〉 20 were significantly associated with IRAB HAP. Multivariate Logistic regression analysis showed that previous use of carbapenem within 28 days before isolation of AB and A- PACHE II score on admission 〉I 20 were independent risk factors for IRAB HAP. The resistant rate of IRAB to amikacin was lower （38.7%）, and the resistant rate to cefoperazone sulbactam was up to 64.5%. Compared to ISAB, the resistance rates of IRAB to most of the antimicrobial drugs increased significantly. The mortality of IRAB group was obviously higher. Conclusion Previous use of car- bapenem within 28 days before isolation of AB and APACHE II score on admission i〉 20 are independent risk factors for IRAB HAP. The drug resistance of IRAB is extremely serious, all of which are multi-drug resistant strains. IRAB HAP patients are subject to poor progno- sis and high mortality.

关 键 词：鲍曼不动杆菌 亚胺培南 医院获得性肺炎 危险因素 耐药性分析 

分 类 号：R378[医药卫生—病原生物学]