初始不适当抗菌治疗对ICU鲍曼不动杆菌感染患者死亡率的影响  

Effect of inappropriate initial antibiotic therapy on mortality by Acinetobacter baumannii infection in ICU patients

作　　者：李海红[1] 刘永良[2] 姚立岩[3] 王清文 谢凤杰[1] 

机构地区：[1]牡丹江医学院红旗医院重症医学科,黑龙江牡丹江157011 [2]牡丹江医学院红旗医院麻醉科,黑龙江牡丹江157011 [3]牡丹江医学院公共卫生学院,黑龙江牡丹江157011 [4]黑龙江省牡丹江市传染病医院,黑龙江牡丹江157011

出　　处：《热带医学杂志》2015年第8期1041-1044,共4页Journal of Tropical Medicine

基　　金：黑龙江省自然基金(LC201427)

摘　　要：目的分析ICU鲍曼不动杆菌感染患者死亡的独立危险因素,探讨初始不适当抗菌治疗对ICU鲍曼不动杆菌感染患者死亡率的影响。方法回顾性分析ICU病房收治的患者,以检出鲍曼不动杆菌的患者作为研究对象,分离菌株进行抗菌药物敏感性试验、收集临床信息并分为死亡组和存活组,对可能引起患者死亡的因素资料进行单因素分析与Logistic回归分析。结果共检出鲍曼不动杆菌感染的患者75例(死亡组37例,存活组38例),感染率为11.1%;鲍曼不动杆菌对哌拉西林-他唑巴坦、头孢吡肟、氨苄西林-舒巴坦的耐药率分别为89.3%、85.3%、84.0%;APACHEⅡ评分、碳青霉烯耐药及初始不适当抗菌治疗为鲍曼不动杆菌感染患者死亡的独立危险因素,差异具有统计学意义(P<0.05)。结论初始不适当抗菌治疗增加ICU鲍曼不动杆菌感染患者死亡率。鲍曼不动杆菌耐药现象比较严重,应加强耐药性监测。Objective To analyze the risk factors of the patients death caused by Acinetobater baumanii in intensive care unit（ICU） and discuss the effects on mortality in Acinetobacter baumannii infected patients after inappropriate initial antimicrobial treatment. Methods Patients were collected and analyzed retrospectively in ICU. The patients with Acinetobater baumanii infection were studied and divided into death group and survival group. Clinical information was collected. The strains were isolated and antibiotics susceptibility test were performed. The factors that could cause death in patients were analyzed using univariate analysis and logistic regression analysis. Result 75 cases were identified as A.baumannii infection（death group 37 cases and survival group 38 cases）,with the infection rate of 11.1%. The susceptibility rates of Acinetobacter baumannii to piperacillin-tazobactam, cefepime, ampicillin-sulbactam were 89.3%,85.3% and 84.0%, respectively. APACHE II score, carbapenem resistance and initial inappropriate antimicrobial therapy were independent risk factors of death in patients with Acinetobacter baumannii infection; the differences were statistically significant（P〈0.05）. Conclusions Inappropriate initial antimicrobial therapy could increase Acinetobacter baumannii infection and the mortality. The phenomenon of Acinetobacter baumannii drug resistance was more serious. The monitoring of drug resistance should be strengthened.

关 键 词：初始不适当抗菌治疗 鲍曼不动杆菌 危险因素 碳青霉烯耐药 

分 类 号：R516[医药卫生—内科学]