呼吸科泛耐药鲍曼不动杆菌感染的危险因素分析  

Analysis of risk factors for pandrug-resistant Acinetobacter baumannii infection in Respiratory Department

作　　者：徐雄[1] 徐斌[1] 王玉月[1] 徐乾乾 闫廷赞[1] 

机构地区：[1]常州市第一人民医院呼吸科,江苏常州213000

出　　处：《热带医学杂志》2014年第12期1613-1616,共4页Journal of Tropical Medicine

摘　　要：目的研究呼吸科泛耐药鲍曼不动杆菌（PDR-AB）感染的相关危险因素,为院内泛耐药鲍曼不动杆菌感染的防治提供依据。方法采用病例对照研究,收集常州市第一人民医院呼吸科2012年1月1日至2013年12月31日泛耐药鲍曼不动杆菌感染的86例患者的病例资料,并选择同时期普通鲍曼不动杆菌感染的49例患者作为对照,采用χ2检验和非条件Logistic回归分析PDR-AB感染的危险因素。结果单因素分析显示：机械通气、气管插管（切开）、放置胃管、导尿管、住呼吸科重症监护室（RICU）≥7 d、使用三代头孢菌素、半合成青霉素类、碳氢酶烯类抗菌素、使用三种以上抗菌素及使用抗菌素≥7 d是泛耐药鲍曼不动杆菌感染的危险因素（P〈0.05）。多因素Logistic回归分析显示：泛耐药鲍曼不动杆菌感染的独立危险因素有住呼吸科重症监护室（RICU）≥7 d（OR=8.31,95%CI：1.73~39.79）、使用三代头孢菌素（OR=8.08,95%CI：1.95~33.45）、半合成青霉素类（OR=4.76,95%CI：1.02~22.16）、碳氢酶烯类抗菌素（OR=32.16,95%CI：2.14~484.24）、使用三种以上抗菌素（OR=22.39,95%CI：3.44~145.93）及使用抗菌素≥7 d（OR=40.24,95%CI：1.90~167.24）。结论泛耐药鲍曼不动杆菌感染与三代头孢菌素、半合成青霉素类、碳氢酶烯类抗菌素的使用及入住监护室密切相关,临床应规范此类抗菌素的使用,尽可能缩短使用时间及减少联合用药,以控制泛耐药鲍曼不动杆菌的感染。Objective To study the risk factors of pandrug-resistant Acinetobacter baumannii（PDR-AB） infection in the Respiratory Department and provide basis for the prevention and treatment of PRD-AB. Methods In this case-control study, data of 86 cases infected by PDR-AB from Jan 2012 to Dec 2013 were collected in the Respiratory Department of the Changzhou First People’s Hospital. 49 cases infected by common Acinetobacter baumannii were chosen as control.Univariate analysis（chisquare test） and Logistic regression were used for statistical analysis. Results Univariate analysis revealed the risk factors for infection by PRD-AB include the following ： mechanical ventilation, tracheal intubation（tracheotomy）, placement of gastric tube or aurinary catheter, be hospitalized in RICU ≥ 7 days, use of the third generation cephalosporin,use of semi synthetic penicillins,use of cabapenems, using more than three kinds of antibiotics and use of antibiotics for more than 7 days（P 〈0.05）. Multivariate logistic regression analysis showed independent risk factors for infection by PRD-AB include the following ： be hospitalized in RICU ≥ 7 days（OR =8.31,95% CI ：1.73 ~39.79）, use of the third generation cephalosporin（OR =8.08,95% CI ：1.95 ~33.45）, use of semi synthetic penicillins（OR =4.76,95%CI：1.02~22.16）, use of cabapenems（OR =32.16,95% CI：2.14~484.24）, using more than three kinds of antibiotics（OR =22.39,95% CI：3.44 ~145.93） and use of antibiotics for more than 7 days（OR =40.24,95% CI：1.90 ~167.24）. Conclusion The PRD-AB infection was closely related to the use of the third generation cephalosporin, the use of semi synthetic penicillins, the use of cabapenems and the hospitalized time in RICU. To control the PRD-AB infection, we should standardize the use of this class of antibiotics, shorten the time and reduce the use of combination antibiotics.

关 键 词：鲍曼不动杆菌 泛耐药 危险因素 

分 类 号：R378[医药卫生—病原生物学]