鲍曼不动杆菌血流感染临床特征和死亡危险因素分析  

Analysis of clinical manifestations and risk factors of mortality in Acinetobacter baumannii bloodstream infection

作　　者：张银维[1] 周华[1] 蔡洪流[2] 杨青[3] 沈茜[1] 沈毅弘[1] 周建英[1] 

机构地区：[1]浙江大学医学院附属第一医院呼吸内科,杭州310003 [2]浙江大学医学院附属第一医院重症监护室,杭州310003 [3]浙江大学医学院附属第一医院检验科,杭州310003

出　　处：《中华内科杂志》2016年第2期121-126,共6页Chinese Journal of Internal Medicine

基　　金：浙江省医药卫生科技计划项目（2013KYA068）;浙江省教育厅科研项目（Y201223800）;浙江省中医药（中西医结合）重点学科建设项目（2012-XK-A18）

摘　　要：目的探讨鲍曼不动杆菌血流感染患者的临床特征、抗菌药物治疗及死亡的危险因素。方法回顾性分析2013年1月至2014年9月浙江大学医学院附属第一医院住院的153例鲍曼不动杆菌医院血流感染患者的临床资料。根据28d预后分为死亡组（76例）和存活组（77例），收集人口学资料、基础疾病、治疗及侵人性操作、细菌耐药性、发病时急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、抗菌药物治疗方案；通过多因素logistic回归分析死亡独立危险因素。结果本研究共纳入153例鲍曼不动杆菌血流感染患者，28d病死率49．7％。APACHEⅡ≥22分（OR=15．7，95％CI为5．1～48．1，P〈0．001）、合并感染性休克（OR=6．3，95％CI为1．9～21．3，P=0．003）及糖皮质激素治疗（OR：3．6，95％C1为1．0～12．3，P=0．043）是鲍曼不动杆菌血流感染患者死亡的独立危险因素。多重耐药鲍曼不动杆菌（MDR—AB）感染患者抗菌药物治疗方案中，以头孢哌酮一舒巴坦为基础的治疗组7d、14d、28d病死率（8．9％、31．1％、44．4％）均低于非头孢哌酮一舒巴坦治疗组（59．2％、65．8％、72．4％），差异均有统计学意义（P值分别为〈0．001、〈0．001及0．002）。结论鲍曼不动杆菌血流感染的病死率高。发病前糖皮质激素治疗、合并感染性休克、发病时APACHEⅡ评分≥22分提示预后差。以头孢哌酮一舒巴坦为基础抗菌药物治疗方案可改善患者的预后。Objective To explore the clinical manifestations, antimicrobial therapy, and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection. Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively. According to the 28- day survival after diagnosis, the patients were divided into death group （ n = 76 ） and survival group （ n = 77 ）. Data related to demographic and clinical characteristics, underlying diseases, treatment, invasive procedures, bacterial resistance to antibiotics, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）scores at onset, and antimicrobial therapy were collected. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results This study included 153 patients with Acinetobacter baumannii bloodstream infection. The 28-day mortality was 49. 7%. The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset （ OR = 15.7, 95 % CI 5. 1 - 48.1, P 〈 0. 001 ）, septic shock （ OR = 6. 3,95% CI 1.9 - 21.3, P = 0. 003 ）, and administration of steroids （ OR = 3.6,95% C1 1.0 -12. 3, P = 0. 043）. Compared with subjects treated with non-cefoperazone-sulbactam- based regimen , those treated with cefoperazone-sulbactam for muhidrug-resistant Acinetobacter baumannii （MDR-AB） had significantly lower mortality on day7, dayl4 and day28 （8. 9% vs 59.2% ,31.1% vs 65.8%, 44. 4% vs 72. 4% respectively ） . Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month. Administration of steroids and septic shock are associated with poor prognosis. APACHE 11 score ≥ 22 at onset predicts adverse outcome. Cefoperazone- sulbactam-based antimicrobial therapy improves patients＇ survival.

关 键 词：鲍曼不动杆菌 血流感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]