亚胺培南耐药鲍曼不动杆菌医院感染危险因素分析  

Risk factors for nosocomial infections caused carbapenem-resistant Acinetobacter Baumanii(CRAB):a case-control study

作　　者：叶继辉[1] 李超芬 丁群力[3] 

机构地区：[1]宁波市第一医院重症医学科,315000 [2]宁波市第九医院微生物实验室 [3]宁波大学附属医院呼吸内科

出　　处：《浙江医学》2015年第4期300-303,316,共5页Zhejiang Medical Journal

摘　　要：目的了解亚胺培南耐药鲍曼不动杆菌（CRAB）医院感染的危险因素，并探讨I类整合子在鲍曼不动杆菌亚胺培南耐药中的作用。方法选取确诊为CRAB医院感染患者54例作为病例组，按1：3配对选择162例亚胺培南敏感鲍曼不动杆菌（CSAB）医院感染患者作为对照组。采用单因素分析及多因素logistic回归分析其危险因素。PCR检测I类整合酶基因。结果单因素分析发现，与CRAB医院感染相关的危险因素有病情危重、入住ICU时间、住院时间≥14d、机械通气／人工气道、留置尿管、中心静脉置管、免疫抑制剂的使用、抗生素使用时间≥7d、抗生素药物种类≥3种。多因素logistic回归分析发现，病情危重（OR：8．47；95％CI：1．56～46．0）、入住ICU时间（OR：9．32；95％CI：1．83～47．43）、住院天数≥14d（OR：13．89；95％CI：3．07～62．85）、机械通气／人工气道（OR：18．86；95％C1：4．38～81．31）、抗生素使用种类≥3种（OR：6．16；95％CI：1．85～20-51）、抗生素使用时间≥7d（OR：541：95％CI：136～21．58）是CRAB医院感染的独立危险因素；CRAB组中I类整合酶基因检出率（59．3％）显著高于CSAB组（34．6％），差异有统计学意义（P〈0．001）。结论病情危重、入住ICU时间、住院时间、机械通气／人工气道、抗生素使用种类≥3种、抗生素使用时间≥7d是CRAB医院感染的独立危险因素，I类整合子在CRAB中普遍存在。需加强对相关危险因素的控制及耐药机制的研究，早期防治CRAB医院感染的发生。Objective To investigate the risk factors for nosocomial infections caused by carbapenem-resistant Acinetobacter Baumanii（CRAB）. Methods Fifty-four patients with nosocomial infection by CRAB （cases） and 162 matched patients with nosocomial infection by carbapenem-susceptible Acinetobacter Baumanii （CSAB） as controls admitted in hospital from January 2012 to December 2012 were included in the study. Univariate analysis and multivariate logistic regression were used to analyze the risk factors for nosocomial infection by CSAB. Class I integron was detected by PCR. Results Univariate analysis revealed that the risk factors for nosocomial infection by CRAB were pathogenetic condition, ICU stay, hospitalization ≥14d, mechanical ventilation/artificial airway, urinary catheter, central venous catheter, administration of immunosuppressive agents, treatment with ≥ kinds of antibiotics and ≥7d. Multivariate logistic regression analysis identified six independent risk factors： pathogenetic condition（OR 8.47; 95% C I 1.56- 46.0）, ICU stay （OR 9.32; 95% CI 1.83- 47.43）, hospitalization ≥ 14d （OR 13.89;95% CI 3.07- 62.85）, mechanical ventilation/artificial airway （OR 18.86; 95% CI 4.38 - 81.31）, treatment with≥3 kinds of antibiotics（OR 6.16; 95% CI 1.85 - 20.51） and ≥ 7d （OR 5.41; 95% CI 1.36 - 21.58）. Detection rate of class I integron among CRAB was significantly higher than that in CSAB（59.3% vs 34.6%, P〈0.001）. Conclusion Pathogenetic condition, ICU stay, hospitalization ≥14d, mechanical ventilation/artificial airway, treatment with more than 3 kinds of antibiotics, using antibiotics ≥7d are likely to be risk factors for nosocomial infection by CRAB, and Class I integron are common in the CRAB.

关 键 词：亚胺培南耐药鲍曼不动杆菌 医院感染 危险因素 I类整合子 

分 类 号：R446.5[医药卫生—诊断学]