ICU患者多药耐药鲍氏不动杆菌血流感染影响因素及其耐药性  

Influencing factors and drug resistance of multi-drug resistance Acinetobacter baumannii bloodstream infection in ICU patients

作　　者：范学军 许芳杰 陈刚[1] 黄坤 李柯 FAN Xue-jun;XU Fang-jie;CHEN Gang;HUANG Kun;LI Ke(Jiaozuo People's Hospital,Jiaozuo,Henan 454150,China)

机构地区：[1]河南省焦作市人民医院ICU北区,河南焦作454150

出　　处：《中华医院感染学杂志》2021年第3期346-349,共4页Chinese Journal of Nosocomiology

基　　金：河南省科研基金资助项目(2018021141)。

摘　　要：目的回顾性分析ICU患者多药耐药鲍氏不动杆菌血流感染的临床特征、影响因素及耐药性。方法收集2016年2月-2019年2月焦作市人民医院ICU鲍氏不动杆菌血流感染患者84例的病例资料,总结ICU多药耐药鲍氏不动杆菌血流感染患者临床特征和耐药性变迁趋势,归纳ICU患者多药耐药鲍氏不动杆菌血流感染的影响因素。结果多药耐药组53例患者平均年龄(58.51±15.37)岁,其中65岁以上28例(52.83%);均表现有不同程度发热,外周血白细胞总数及中性粒细胞占比明显升高,病死率为37.74%;入住ICU时间(OR=2.349)、深静脉置管(OR=1.289)、前期使用碳青霉烯类抗菌药物(OR=2.063)是ICU患者多药耐药鲍氏不动杆菌血流感染的影响因素(P<0.05)。药敏结果显示,84例鲍氏不动杆菌对常见抗菌药物耐药率均>50%,其中对氨苄西林/舒巴坦和亚胺培南的耐药率稍低,分别为70.24%、67.86%;而且对氨苄西林/舒巴坦、阿米卡星、头孢噻肟、头孢他啶、头孢曲松、环丙沙星及亚胺培南的耐药性逐年升高。结论对于ICU多药耐药鲍氏不动杆菌血流感染临床可用药物有限,患者预后差,应针对性干预影响因素,严格掌握药物用药指征,以减少多药耐药菌株产生。OBJECTIVE To retrospectively analyze the clinical features, influencing factors and drug resistance of multi-drug resistance Acinetobacter baumannii(AB) bloodstream infection in ICU patients. METHODS The clinical data of 84 patients with AB bloodstream infection in ICU of Jiaozuo People′s Hospital from Feb. 2016 to Feb. 2019 were collected. The clinical features and trends of drug-resistance in ICU patients with multi-drug resistance AB bloodstream infection were summarized, and the influencing factors of ICU patients with multidrug-resistant AB bloodstream infection were summarized. RESULTS(35 males, 18 females) with multi-drug resistance AB bloodstream infection, the average age of the 53 patients was(58.51±15.37) years old, of which 28 cases(52.83%) were 65 years and older. All patients showed different degrees of fever, the total number of white blood cells and proportion of neutrophils in peripheral blood increased significantly, and the fatality rate was 37.74%. ICU admission time(OR=2.349), deep vein catheterization(OR=1.289), and early use of carbapenems(OR=2.063) anti-bacterial were the independent risk factors of multi-drug resistant AB bloodstream infection in ICU patients(P<0.05). The drug sensitivity results showed that drug resistance rates of the 84 AB to common antibacterial drugs were more than 50%, among which the drug resistance rates to ampicillin/sulbactam and imipenem were slightly lower(70.24% and 67.86%, respectively). And their drug resistance to ampicillin/sulbactam, amikacin, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin and imipenem had been increasing year by year. CONCLUSION The clinically available drugs for multi-drug resistance AB bloodstream infection in ICU were limited, and prognosis of patients was poor. The influencing factors should be intervented, and the medication indicators should be strictly controlled to reduce the production of multi-drug resistant strains.

关 键 词：鲍氏不动杆菌 血流感染 多药耐药 影响因素 临床特征 

分 类 号：R378[医药卫生—病原生物学]