泛耐药鲍曼不动杆菌感染的预后危险因素分析  

Prognostic risk factors of extensively drug-resistant Acinetobacter baumannii infection

作　　者：刘秋萍[1] 顾晓花[2] 汤瑾[3] 王坚镪[3] 任增花 张瑶 徐凌[2] LIU Qiu-ping;GU Xiao-hua;TANG Jin;WANG Jian-qiang;REN Zeng-hua;ZHANG Yao;XU Ling(Department of Respiratory Medicine,Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus,Shanghai Fengxian District Central Hospital,Shanghai 201400,China;Department of Respiratory Medicine,Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai 200030,China;Department of Clinical Laboratory,Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai 200030,China)

机构地区：[1]上海交通大学附属第六人民医院南院(上海市奉贤区中心医院)呼吸内科,上海201400 [2]上海交通大学附属第六人民医院呼吸内科,上海201400 [3]上海交通大学附属第六人民医院检验科,上海201400

出　　处：《临床肺科杂志》2021年第2期223-229,234,共8页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨影响泛耐药鲍曼不动杆菌(Extensively Drug resistance Acinetobacter baumannii,XDRAB)感染预后的危险因素。方法回顾性收集2011年1月至2016年12月在上海市第六人民医院住院且发生XDRAB感染的患者的临床资料,应用单因素分析及多因素logistic回归分析影响XDRAB感染预后的危险因素。结果157例XDRAB感染患者中存活90例,死亡67例,死亡率42.68%,logistic多因素回归分析发现,年龄≥65岁、合并心功能不全、住院期间有创通气、住院期间联合抗真菌药物、感染时CRP≥184.63 mg/L、住院期间谷丙转氨酶≥141U/L、住院期间尿素氮≥14.3 mmol/L为影响XDRAB感染预后的独立危险因素,感染XDRAB后抗生素使用持续时间≥6天,是XDRAB感染预后的独立保护因素。结论XDRAB感染死亡率高,高龄、基础疾病重、CRP明显升高、联用抗真菌药物是预后不良的主要因素,减少并发症发生,避免抗真菌药物滥用,适当延长感染XDRAB后抗生素治疗时间,有利于改善预后。Objective To identify prognostic factors associated with mortality of extensively drug-resistant Acinetobacter baumannii(XDRAB)infection.Methods A retrospective study was conducted in Shanghai Sixth People’s Hospital,China.All patients diagnosed with XDRAB infection from January 2011 to December 2016 were eligible.The patients’medical records were reviewed.Univariate and multivariate logistic regression analysis were performed to identify the prognostic factors of mortality.Results A total of 157 patients were clinically diagnosed with XDRAB infection.67 patients died and 90 survived,and the mortality rate for XDRAB infection was 42.68%.Multivariate analysis showed that age≥65 years old,cardiac insufficiency,invasive ventilation,combined use with antifungal drugs during hospitalization,C-reactive protein(CRP)≥184.63 mg/L,alanine aminotransferase≥141U/L and urea nitrogen≥14.3 mmol/L were independent prognostic factors of mortality.On the other hand,the duration of antibiotic treatment after infection with XDRAB(≥6 days)was identified as a protective factor.Conclusion XDRAB infection is associated with high mortality rate.The advanced age,presence of the complications,high CRP and administration with antifungal drugs are the main risk factors of prognosis.It is beneficial to improve the prognosis by prolonging the duration of antibiotic treatment after XDRAB infections,avoiding the abuse of antifungal drugs and reducing the incidence of complications.

关 键 词：泛耐药鲍曼不动杆菌 感染 预后因素 

分 类 号：R516[医药卫生—内科学]