多药耐药鲍氏不动杆菌血流感染病原学特征及危险因素分析  

Pathogenic characteristics and risk factors of multidrug-resistant Acinetobacter baumanii bloodstream infections

作　　者：曾宪焕 孙婧[2] 李琳[2] 华秀芝[2] 康娟[2] 柳殿云 ZENG Xian-huan SUN Jing LI Lin HUA Xiu-zhi KANG Juan LIU Dian-yun(Nanyang Second People＇s Hospital, Nanyang, Henan 473000, Chin)

机构地区：[1]南阳市第二人民医院护理部,河南南阳473000 [2]南阳市第二人民医院内科,河南南阳473000

出　　处：《中华医院感染学杂志》2017年第20期4572-4575,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析多药耐药鲍氏不动杆菌(MDRAB)血流感染的特征,筛选MDRAB血流感染的危险因素。方法选取2013年8月-2016年12月于医院就诊的294例血流感染患者,其中非MDRAB血流感染227例,MDRAB血流感染67例,分析总结MDRAB血流感染患者的临床特征,并采用多因素回归分析方法分析MDRAB血流感染危险因素。结果单因素分析显示年龄≥60岁、合并呼吸衰竭、合并低蛋白血症、合并脏器功能衰竭、进入ICU、APACHEⅡ评分>20分、接受机械通气、预防性应用抗菌药物、深静脉侵入性操作为MDRAB血流感染发生的危险因素(P<0.05);多因素结果显示,合并脏器功能衰竭、进入ICU、APACHEⅡ评分、接受机械通气、预防性应用抗菌药物、深静脉侵入性操作是MDRAB感染独立危险因素(P<0.05);88株MDRAB对阿莫西林、头孢呋辛、阿米卡星等常用抗菌药物耐药率较高,对米诺环素、头孢哌酮舒巴坦耐药率较低。结论 MDRAB对米诺环素和头孢哌酮舒巴坦较敏感,建议重视MDRAB血流感染的防治工作,选择高敏感性药物以提高预后效果。OBJECTIVE To analyze the characteristics of multidrug-resistant Acinetobacter baumanii（MDRAB）bloodstream infections,and to screen the risk factors of MDRAB bloodstream infection.METHODS A total of 294 patients with bloodstream infections enrolled in our hospital from Aug.2013 to Dec.2016 were selected.Among them,227 cases were of non-MDRAB bloodstream infections,and 67 cases were of MDRAB bloodstream infections.The clinical characteristics of MDRAB patients with bloodstream infections were analyzed and summarized,and the risk factors of MDRAB bloodstream infection were identified by multivariate regression analysis.RESULTS Univariate analysis showed that the no less than 60 years of age,combined with respiratory failure,with hypoalbuminemia,with organ failure,entering ICU,APACHE Ⅱ score 20 points,accepting mechanical ventilation,prophylactic use of antibiotics,and deep vein invasive operation were the risk factors of MDRAB bloodstream infections（P〈0.05）.Multivariate regression analysis showed that combined with organ failure,entering ICU,APACHE Ⅱscore,accepting mechanical ventilation,prophylactic use of antibiotics,and deep vein invasive operation were the independent risk factors for MDRAB infections（P〈0.05）.The results of drug resistance analysis of 88 strains of MDRAB showed that the resistant rates of MDRAB to cefuroxime,amoxicillin and amikacin were high,and to minocycline and cefoperazone sulbactam was low.CONCLUSION MDRAB is sensitive to minocycline and cefoperazone sulbactam.It is recommended to pay attention to the prevention and treatment of MDRAB bloodstream infections,and to select high sensitivity drugs to improve the prognosis.

关 键 词：多药耐药鲍氏不动杆菌 血流感染 病原学特征 危险因素分析 

分 类 号：R378[医药卫生—病原生物学]