鲍曼不动杆菌感染28d死亡危险因素分析  

Analysis of risk factors on 28-day mortality for Acinetobacter Baumannii infection

作　　者：邱泽亮[1] 沈侃[1] 许东伟[1] 李红鹏[1] 李秀华[1] 邹春华[2] 姜建新[2] 

机构地区：[1]上海健康医学院附属周浦医院ICU,上海201318 [2]上海健康医学院附属周浦医院感染管理科,上海201318

出　　处：《中国急救医学》2017年第3期238-241,F0003,共5页Chinese Journal of Critical Care Medicine

基　　金：上海市卫生和计划生育委员会面上项目（201540420）;上海市健康医学院种子基金项目自然科学类重点项目（HMSF-16-21-026）;上海市浦东新区卫生系统学科带头人人才培养计划（PWRd2016-08）

摘　　要：目的探讨影响患者鲍曼不动杆菌感染预后的危险因素。方法回顾性分析2014—01～2015-01上海健康医学院附属周浦医院ICU95例鲍曼不动杆菌感染患者的病例资料。根据28d预后分为死亡组和存活组，收集人口学资料、人住科室、标本来源、感染程度、治疗及有创操作、细菌耐药性和发病时急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。采用Cox比例风险模型分析确定独立危险因素，Kaplan—Meier生存分析比较预后情况。结果同期21491例住院患者中有95例发生鲍曼不动杆菌院内感染，发生率为4．56％，28d病死率为26．32％；其中，47例（49．47％）为耐碳青霉烯类鲍曼不动杆菌（CRAB），病死率为40．43％。经混杂因素调整后，感染性休克（RR=2．75，95％CI 1．16～6．54，P=0．02）和CRAB（RR=2．84，95％CI 1．07～7．52，P=0．04）是影响鲍曼不动杆菌感染患者28d死亡的两个独立危险因素。Kaplan—Meier生存分析也显示，CRAB感染组生存时间较碳青霉烯类敏感鲍曼不动杆菌（CSAB）组短（平均生存时间为22．32d vs．26．25d，P=0．02）；感染性休克组生存时间较非感染性休克组生存时间短（平均生存时间为19．26d vs．25．25d，P=0．000）。结论细菌对碳青霉烯类耐药情况和感染的严重程度皆为鲍曼不动杆菌感染患者死亡的主要危险因素。Objective To explore the risk factors on prognosis of Acinetobacter Baumannii infection. Methods Clinical data from 95 patients with Acinetobacter Baumannii infection hospitalized in Zhoupu Hospital Affiliated to Shanghai University of Medicine ＆ Health Sciences from January 2014 to January 2015 were analyzed retrospectively. According to the 28-day prognosis after admission, the patients were divided into non-survivors and survivors. Data on demographic and clinical characteristics, wards, underlying diseases, specimen source, severity of infection, invasive medical procedures, bacterial resistance to antibiotic, and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score in the beginning were collected. The index as an independent risk factor of morality was demonstrated by multi- variate Cox regression analysis. The prognosis was compared by Kaplan-Meier survival analysis. Resuits During the study period, 21 491 patients were admitted to the hospital. Of them, 95 （4.56%0） patients were infected by Acinetobacter Baumannii. The 28-day mortality was 26.32% （31/66）. The multivariate Cox proportional model revealed that septic shock （RR 2.75, 95% CI 1.16- 6.54, P = 0.02） and carbapenem-resistant Acinetobacter Baumannii （CRAB） infection （RR 2.84, 95% CI 1.07 - 7.52, P = 0.04） were independent predictors of the 28-day prognosis in patients with Acinetobacter Baumannii infection. Kaplan-Meier survival analysis also showed that subjects in the CRAB group had a shorter mean survival time than those in the CSAB group （22.32 d vs. 26.25 d respectively, P = 0.002）. A similar phenomenon for mean survival time was observed when the subjects were divided by septic shock or not （septic shock group： 19.27 d, without septic shock group： 25.25 d, P = 0.000）. Conclusion CRAB infection or not and severity of infection presentation are major risk factors for mortality in patients with Acineto- bacter baumannii infection.

关 键 词：鲍曼不动杆菌 危险因素 碳青霉烯类耐药 感染性休克 预后 

分 类 号：R515[医药卫生—内科学]