老年患者耐碳青霉烯类鲍曼不动杆菌感染的耐药性及预后影响因素分析  

Drug resistance and prognostic risk factors of elderly patients with carbapenem-resistant Acinetobacter baumannii infection

作　　者：谭莉 曾莉怡 吴健 熊迪 段群群 李美华 Tan Li;Zeng Liyi;Wu Jian;Xiong Di;Duan Qunqun;Li Meihua(Department of Geriatrics,Zhuzhou Central Hospital,Zhuzhou 412000,China;Department of Nosocomial Infection Management,Zhuzhou Central Hospital,Zhuzhou 412000,China)

机构地区：[1]湖南省株洲市中心医院老年病科,412000 [2]湖南省株洲市中心医院医院感染管理科,412000

出　　处：《中国实用医刊》2021年第1期21-24,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析老年患者耐碳青霉烯类鲍曼不动杆菌(CR-AB)感染的耐药性及预后的影响因素,确定急性生理学与慢性健康状况评分Ⅱ(APACHE II评分)对CR-AB老年感染者死亡的预测作用。方法抽取株洲市中心医院2018年1月至2019年12月收治的老年CR-AB感染患者为研究对象,监测其CR-AB感染情况。依据感染后30 d内预后将患者分为死亡组(57例)和存活组(139例)。分析CR-AB感染老年患者的耐药性,统计分析老年CR-AB感染患者预后的危险因素。结果 2018年至2019年株洲市中心医院共196例年龄≥65岁患者发生CR-AB感染,感染部位以呼吸道最为常见,CR-AB对β-内酰胺类、氨基糖苷类耐药率最高,耐药率均>90.0%,其次为复方新诺明耐(65.1%)、替加环素(44.8%),未产生多粘菌素耐药。Logistic多因素分析结果显示,年龄、入院后曾使用碳青霉烯类抗生素、机械通气时间≥7 d、高APACHEⅡ评分是影响CR-AB老年感染者预后的独立危险因素(P<0.05)。APACHEⅡ评分预测CR-AB感染老年患者死亡的受试者工作特征曲线下面积为0.754(95%CI:0.686~0.822,P<0.001),临界诊断值为26.5分,敏感度和特异度分别为64.9%、70.5%。结论老年CR-AB感染患者耐药情况严重,如患者入院后感染前使用过碳青霉烯类抗生素、机械通气时间≥7 d以及高APACHEⅡ评分要警惕预后不良,APACHEⅡ评分对老年CR-AB感染患者的预后具有预测价值。Objective To analyze drug resistance and risk factors of prognosis in elderly patients with carbapenem-resistant Acinetobacter baumannii(CR-AB)infection,and to further determine the value of acute physiology and chronic health evaluationsⅡ(APACHEⅡ)score in predicting death in elderly patients with CR-AB infection.Methods The disease condition of elderly patients with CR-AB infection treated in Zhuzhou Central Hospital from January 2018 to December 2019 was monitored.According to prognosis within 30 days after infection,the patients were divided into death group(n=57)and survival group(n=139).The drug resistance of the two groups was analyzed.Risk factors influencing prognosis of elderly patients with CR-AB infection were recorded and analyzed.Results During 2018 to 2019,a total of 196 patients(age≥65 years)were infected by CR-AB,with respiratory tract as the most common infection source.In elderly patients with CR-AB infection,the resistance toβ-lactam and aminoglycoside antibiotics was the highest(drug resistance rate>90.0%),followed by compound sulfamethoxazole(65.1%)and teicycline(44.8%),and no polymyxin resistance occurred.Logistic multivariate analysis showed that age,previous use of carbapenem antibiotics after admission,duration of mechanical ventilation≥7 d,and high APACHEⅡscore were independent risk factors of prognosis in elderly patients with CR-AB infection(P<0.05).The area under the receiver operating characteristic curve of APACHEⅡscore for predicting death in elderly patients with CR-AB infection was 0.754(95%CI:0.686-0.822;P<0.001),the cut-off points for diagnosis was 26.5,and the sensitivity and specificity were 64.9%and 70.5%,respectively.Conclusions The drug resistance of elderly patients with CR-AB infection is serious,and poor prognosis may occur in patients with the use of carbapenem antibiotics before infection and after admission,mechanical ventilation time≥7 d,and high APACHEⅡscore.APACHEⅡscore has predictive value for the prognosis of elderly patients with CR-AB infect

关 键 词：耐碳青霉烯类鲍曼不动杆菌 耐药性 预后因素 

分 类 号：R446.5[医药卫生—诊断学]