慢性难愈合创面中耐亚胺培南鲍曼不动杆菌的耐药性及其危险因素分析  

Drug resistance of Acinetobacter baumannii in chronic refractory wound and risk factors of infection

作　　者：孙永宁[1] 王晗 王福斌[1] SUN Yongning;WANG Han;WANG Fubin(Department of Clinical laboratory,Ningbo Sixth Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院检验科,315040 [2]温州市人民医院检验科

出　　处：《浙江医学》2018年第20期2257-2260,2263,共5页Zhejiang Medical Journal

摘　　要：目的分析慢性难愈合创面中耐亚胺培南鲍曼不动杆菌的耐药性及危险因素。方法回顾110例慢性难愈合创面分泌物中分离鲍曼不动杆菌住院患者的临床资料,根据药物敏感试验结果将患者分为耐亚胺培南组和非耐亚胺培南组,比较两组患者对常用抗菌药物的耐药情况,并对耐亚胺培南鲍曼不动杆菌医院感染可能的危险因素进行单因素分析及多因素log is tic回归分析。结果 110株鲍曼不动杆菌中耐亚胺培南菌株68株,非耐亚胺培南菌株42株。耐亚胺培南组患者对常用抗菌药物的耐药率高于非亚胺培南组患者,差异有统计学意义,两组均未检测出对替加环素耐药的菌株。单因素分析结果显示,多发性损伤、入住ICU、入住ICU的时间>7d、多次清创、混合感染、气管插管、深静脉穿刺、使用第三代头孢菌素、使用碳青霉烯类药物、合并骨髓炎、年住院次数>2次是慢性难愈合创面中分发生耐亚胺培南鲍曼不动杆菌感染的危险因素(均P<0.05)。多因素logistic分析结果显示,多发性损伤(OR=9.424)、入住ICU(OR=10.487)、多次清创(OR=8.479)、气管插管(OR=8.133)、深静脉穿刺(OR=101.902)、碳青霉烯类的使用(OR=14.400)为慢性难愈合创面发生耐亚胺培南鲍曼不动杆菌感染的独立危险因素。结论耐亚胺培南的鲍曼不动杆菌的多重耐药现象严重,应针对危险因素作出预防,减少耐药菌的发生。Objective To analyze drug resistance of Acinetobacter baumannii in chronic refractory wound and the riskfactors of infection. Methods The clinical data on 110 cases of chronic refractory wound in hospital during January 2014 andAugust 2016 were retrospectively analyzed. According to the results of drug sensitive test Acinetobacter baumannii were dividedinto imipenem-resistant group and non- imipenem-resistant group. Drug resistance to commonly used antibiotics was observedin two groups. Multivariate Logistic regression analysis was performed to identify risk factors of imipenem-resistant Acinetobacterbaumannii infection. Results There were 68 imipenem-resistant strains and 42 non-imipenem-resistant strains from theisolated Acinetobacter baumannii strains. The resistance rate of imipenem-resistant group to commonly used antibiotics washigher than that of non- imipenem-resistant group, however, no tigecycline-resistance was found in both groups. Univariateanalysis showed that multiple injuries, admission in ICU, ICU stay 〉7d, repeated debridement, mixed infection, trachealintubation, deep vein puncture, use of third generation cephalosporins, carbapenems, osteomyelitis, repeated hospitalization inone year were associated with imipenem-resistant Acinetobacter baumannii infection in chronic refractory wounds （字2=9.86, 8.80,5.78, 12.41, 7.29, 15.00, 21.37, 14.25, 8.80, 10.80 and 7.30, P〈0.01）. Multivariate analysis showed that multiple injuries（OR=9.424）, ICU stay （OR=10.487）, multiple debridement （OR=8.479）, tracheal intubation （OR=8.133）, deep vein puncture（OR=101.902）, use of carbapenem （OR=14.400） were independent risk factors for imipenem-resistant Acinetobacter baumanniiinfection. Conclusion The situation of multidrug resistance of imipenem-resistant Acinetobacter baumannii is serious. Accordingto the risk factors, necessary measures should be taken to reduce the drug-resistant bacteria infection.

关 键 词：鲍曼不动杆菌 危险因素 慢性难愈合创面 亚胺培南 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]