神经外科重症病房鲍氏不动杆菌临床分布及影响因素分析  

Clinical distribution of Acinetobacter baumannii strains in intensive care units of neurosurgery department and influencing factors

作　　者：陈晓青[1] 温鸿[2] 姚明亚[1] 范素桢 陈晓荷[1] 叶凯丽 CHEN Xiao-qing;WEN Hong;YAO Ming-ya;FAN Su-zhen;CHEN Xiao-he;YE Kai-li(The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325015,China)

机构地区：[1]温州医科大学附属第一医院脑外科重症病房,浙江温州325015 [2]温州医科大学附属第一医院医院感染处,浙江温州325015

出　　处：《中华医院感染学杂志》2018年第13期1969-1971,1986,共4页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(LY16H090015)

摘　　要：目的分析影响神经外科重症病房鲍氏不动杆菌感染的影响因素,为临床治疗提供参考。方法回顾性分析2014年2月-2016年2月医院神经外科重症病房收治的508例患者临床资料,分析患者个体情况及医护措施不同水平患者鲍氏不动杆菌感染率,采用多因素Logistic分析患者感染鲍氏不动杆菌的相关因素,分析感染部位分布及病原菌对临床常用抗菌药物的药敏结果。结果 508例患者中感染鲍氏不动杆菌21例占4.13%,共检出鲍氏不动杆菌45株;多因素分析显示患者住院时间>3周、入住神经外科重症病房时间>2周、体质量指数(BMI)<23、侵入操作>5次、抗菌药物暴露>5次/周、糖尿病是患者感染鲍氏不动杆菌的相关因素;患者感染部位分布以呼吸系统、泌尿系统、血液、创口为主;鲍氏不动杆菌对头孢他啶、氨苄西林-舒巴坦、哌拉西林他唑巴坦等抗菌药物耐药率较高,对氨苄西林、头孢唑林、头孢替坦等较敏感。结论影响神经外科重症病房患者感染鲍氏不动杆菌因素较多,临床应综合考虑治疗措施的疗效和感染风险之间的关系,尽可能增强患者免疫功能,加强医护人员无菌规范操作管理,降低神经外科重症病房鲍氏不动杆菌感染风险。OBJECTIVE To investigate the influencing factors for Acinetobacter baumannii infection in intensive care unit（ICU）of neurosurgery department so as to provide guidance for clinical treatment.METHODS The clinical data of 508 patients who were treated in the ICU of neurosurgery department from Feb 2014 to Feb 2016 were retrospectively analyzed,the individual condition of the patients and incidence of A.baumannii infection were observed,multivariate logistic analysis was performed for the related factors for the A.baumannii infection,and the distribution of infection sites and results of drug susceptibility testing for commonly used antibiotics were observed.RESULTS Of the 508 patients,21 had A.baumannii infection,accounting for 4.13%.A total of 45 strains of A.baumannii were isolated.The multivariate analysis showed that the related factors for the A.baumannii infection included length of hospital stay more than 3 weeks,neurosurgery department ICU stay more than 2 weeks,body mass index（BMI）less than 23,more than 5 times of invasive operation,exposure to antibiotics more than 5 times per week and diabetes mellitus.Respiratory system,urinary system,blood and wound were dominant among the infection sites.The A.baumannii strains were highly resistant to ceftazidime,ampicillin-sulbactam and piperacillin-tazobactam but were susceptible to ampicillin,cefazolin and cefotetan.CONCLUSIONThere are a variety of factors for the A.baumannii infection in the patients of neurosurgery department ICU.It is necessary for the hospital to take into account the effects of treatment measures and the risk of infection as a whole,try to intensify the immune function and strengthen the aseptic operation of health care workers so as to reduce the risk of the A.baumannii infection in the ICU of neurosurgery department.

关 键 词：神经外科重症病房 鲍氏不动杆菌 感染部位分布 影响因素 

分 类 号：R378[医药卫生—病原生物学]