鲍曼不动杆菌院内下呼吸道感染患者发生多重耐药的危险因素分析  

The risk factors of incidence of multidrug resistance caused by Acinetobacter baumannii in patients with nosocomial lower respiratory tract infection

作　　者：王黎一[1] 曹旭华[2] 李红[4] 安雯婷[3] WANG Liyi;CAO Xuhua;LI Hong(Department of Infection Control,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China;不详)

机构地区：[1]河北医科大学第二医院感染控制处,石家庄市050000 [2]河北医科大学第二医院神经外科,石家庄市050000 [3]河北医科大学第二医院科研处,石家庄市050000 [4]华北石油管理局总医院呼吸内科

出　　处：《河北医药》2020年第19期3007-3010,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20180356)。

摘　　要：目的调查鲍曼不动杆菌引起的院内下呼吸道感染患者的病原菌药敏谱及发生多重耐药的危险因素。方法收集2017年院本部确诊为鲍曼不动杆菌引起的院内下呼吸道感染标本184例,其中31例非多重耐药鲍曼不动杆菌(N-MDRAb)作为病例组,153例多重耐药鲍曼不动杆菌(MDRAb)作为对照组。通过病例对照研究的多因素分析,找到发生多重耐药的独立危险因素,为更好地防控院内多重耐药菌感染发生提供参考。结果单因素显示:秋冬季感染、感染前入院>4 d、感染前留置导尿管和感染前使用抗生素者NMDRAb检出率高,差异有统计学意义(P<0.10);2组间其他一般临床资料均具有可比性,差异无统计学意义(P>0.05)。多因素分析秋冬季比春夏季更容易发生NMDR感染,是AB-NP患者发生NMDR的独立易感因素。2组均对头孢哌酮舒巴坦、米诺环素和复方新诺明中度敏感,对多粘菌素B高度敏感。结论在鲍曼不动杆菌引起的院内下呼吸道感染患者中,多粘菌素B为治疗首选药物,在春夏季加强消毒灭菌力度作为今后有效控制院内多重耐药的工作重心。Objective To investigate the risk factors of incidence of multidrug resistance caused by Acinetobacter baumannii in patients with nosocomial lower respiratory tract infection.Methods A total of 184 specimens of nosocomial lower respiratory tract infection caused by Acinetobacter baumannii that were identified in our hospital from January to December in 2017 were collected,in which,there were 31 cases of non-MDRAb(N-MDRAb group)and 153 cases of MDRAb(MDRAb group)were enrolled in the study.According to the results of drug susceptibility testing,the risk factors of incidence of multidrug resistance caused by Acinetobacter baumannii in patients with nosocomial lower respiratory tract infection were analyzed.Results The single factor analysis showed that the detection rate of NMDRAb was higher in the patients with infection in autumn and winter season,the infection duration more than 4 days,and the use of endotracheal intubation and antibiotics before infection(P<0.01).Logistic regretion analysis suggested that utumn and winter were the independent risk factors of incidence of multidrug resistance caused by Acinetobacter baumannii in patients with nosocomial lower respiratory tract infection.Moreover the patients in both groups were moderately sensitive to sulbactam+cefoperazone,minocycline and trimethoprim-sulfamethoxazole,and then were highly sensitive to polymyxin B.Conclusion The polymyxin B is the first choice drug in treatment of nosocomial lower respiratory tract infection caused by Acinetobacter baumannii,moreover,it necessary to focus the work key on the disinfection and sterilization in spring and summer season in the future.

关 键 词：院内下呼吸道感染 鲍曼不动杆菌 多重耐药菌 易感因素 季节 

分 类 号：R563.1[医药卫生—呼吸系统]