ICU机械通气患者感染鲍曼不动杆菌临床特征及预后分析  

Clinical characteristics of acinetobacter baumannii infection in ICU patients with mechanical ventilation and its influence on prognosis

作　　者：陈晨[1] 杨德湘 吴昊[1] 方平[1] CHEN Chen;YANG De-xiang;WU Hao;FANG Ping(Department of Pulmonary and Critical Care Medicine,Tongling People’s Hospital,Tongling,Anhui 244000,China)

机构地区：[1]铜陵市人民医院呼吸与危重症医学科,安徽铜陵244000

出　　处：《临床肺科杂志》2022年第6期862-866,共5页Journal of Clinical Pulmonary Medicine

基　　金：安徽省卫生计生委科研计划项目(No.2016QK001)。

摘　　要：目的分析我院ICU机械通气患者感染鲍曼不动杆菌(Acinetobacter baumannii,AB)临床特征及对预后影响。方法选取2018年1月至2019年12月期间在本院ICU行有创呼吸机机械通气患者136例,常规进行细菌培养、菌株鉴定及药敏实验,统计AB感染情况,分析AB感染组与未感染组的临床特征。根据患者入院后28 d内预后分为生存组与死亡组。单因素及多因素Logistic回归分析影响ICU机械通气AB感染患者预后的危险因素。结果136例患者AB感染率为50.74%。感染组住院时间≥30 d、发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)、机械通气时间≥5 d、连用抗生素时间≥7 d,撤机失败占比,高于未感染组(P<0.05)。AB感染患者住院28 d内死亡46例,死亡组合并感染性休克、多重耐药、CRP升高、APACHEⅡ评分≥15分、撤机失败、深静脉置管占比高于生存组(P<0.05)。多因素Logistic回归分析结果显示,AB感染患者死亡的独立危险因素包括多重耐药、合并感染性休克、APACHEⅡ评分≥15分、深静脉置管(P<0.05)。结论ICU机械通气患者的AB感染率较高,AB感染后易发生VAP,增加撤机失败风险,并延长治疗时间。多重耐药、合并感染性休克、APACHEⅡ评分≥15分、深静脉置管是ICU机械通气AB感染患者预后不良的危险因素。Objective To analyze the clinical characteristics of acinetobacter baumannii(AB)infection in ICU patients with mechanical ventilation and its influence on prognosis.Methods A total of 136 ICU patients with invasive mechanical ventilation from January 2018 to December 2019 were selected.The bacterial culture,strain identification and drug susceptibility tests were routinely conducted,and the clinical characteristics of patients in the AB infected group and the non-infected group were analyzed.According to the prognosis within 28 days after admission,they were divided into the survival group and the death group.Univariate and multivariate logistic regression analysis were used to screen the risk factors affecting the prognosis of patients with AB infection in ICU mechanical ventilation.Results The AB infection rate of the 136 patients was 50.74%.The proportion of hospitalization time≥30 days,associated with ventilator-associated pneumonia(VAP),mechanical ventilation time≥5 days,continuous use of antibiotics time≥7 days and weaning failure in the infected group were higher than those in the non-infected group(P<0.05).46 of patients with AB infection died within 28 days of hospital stay.The proportion of patients combined with septic shock,multi-drug resistance,the elevation of CRP,APACHEⅡ score≥15 points,weaning failure,and deep venous catheterization were higher in the death group than in the survival group(P<0.05).Multivariate logistic regression analysis showed that multi-drug resistance,septic shock,APACHEⅡ score≥15,and deep venous catheterization were the independent risk factors for death of the patients with AB infection on mechanical ventilation in ICU(P<0.05).Conclusion The AB infection rate of patients with mechanical ventilation in ICU is high.VAP is easy to occur after AB infection,which increases the risk of weaning failure and prolongs the treatment time.Multidrug resistance,septic shock,APACHEⅡ score≥15 and deep venous catheterization are the risk factors for poor prognosis in patien

关 键 词：机械通气 鲍曼不动杆菌 临床特征 预后 

分 类 号：R459.7[医药卫生—急诊医学]