机械通气患者鲍氏不动杆菌感染所致呼吸机相关性肺炎的危险因素及临床结局  

Risk factors for Acinetobacter baumannii infection-induced ventilator-associated pneumonia in mechanical ventilation patients and clinical outcomes

作　　者：许国玉[1] 巩月英[1] 吴婧文[1] 常红[1] 李贵君 XU Guo-yu;GONG Yue-ying;WU Jing-wen;CHANG Hong;LI Gui-jun(Qinghai Provincial People's Hospital,Xining,Qinghai 810000,China)

机构地区：[1]青海省人民医院EICU,青海西宁810000

出　　处：《中华医院感染学杂志》2022年第10期1482-1485,共4页Chinese Journal of Nosocomiology

基　　金：青海省科技发展计划基金资助项目(2019118)。

摘　　要：目的 探讨ICU机械通气患者鲍氏不动杆菌(AB)感染所致呼吸机相关性肺炎(VAP)的危险因素及临床结局。方法 选择2016年2月-2020年2月青海省人民医院急诊重症监护室(ICU)行机械通气患者为研究对象,其中选择60例鲍氏不动杆菌感染VAP患者为AB-VAP组,选择同期未发生感染患者62例为对照组。通过病历系统收集患者一般资料,采用单因素分析及多因素Logistic回归分析AB-VAP发生的危险因素,比较两组患者住院临床结局。结果 多因素Logistic回归分析结果,合并糖尿病、侵入性操作史、机械通气时间、APACHEⅡ评分、糖皮质激素治疗时间、抗菌药物联用是ICU机械通气患者发生AB-VAP的独立危险因素(P<0.05),AB-VAP组28 d存活患者例数显著少于对照组,ICU住院时间(16.16±4.18)d及抗感染花费(11.61±3.24)千元均高于对照组,但两组总住院时间差异无统计学意义。结论 AB-VAP患者在临床中抗菌药物选择非常有限,其发生特异性危险因素与常规VAP无明显区别,应注意针对性抗感染预防。OBJECTIVE To explore the risk factors for Acinetobacter baumannii infection-induced ventilator-associated pneumonia(VAP) in ICU patients undergoing mechanical ventilation and observe the clinical outcomes. METHODS The patients who underwent mechanical ventilation in intensive care unit(ICU) of Qinghai Provincial People′s Hospital from Feb 2016 to Feb 2020 were recruited as the study objects, 60 patients with A.baumannii infection-induced VAP were assigned as the AB-VAP group, meanwhile, 62 patients who did not have infection were chosen as the control group. The baseline data were collected from the patients by medical data system. Univariate analysis and multivariate logistic regression analysis were performed for risk factors for the AB-VAP. RESULTS The result of multivariate logistic regression analysis showed that complication with diabetes mellitus, history of invasive operation, time of mechanical ventilation, APACHE Ⅱ score, time of treatment with glucocorticoids and combined use of antibiotics were independent risk factors for the AB-VAP in the ICU patients undergoing mechanical ventilation(P<0.05). The 28-day survival rate of the AB-VAP group was remarkably lower than that of the control group, the length of ICU stay of the AB-VAP group(16.16±4.18)days was longer than that of the control group, and the cost of treatment of infection of the AB-VAP group(11.61±3.24) thousand yuan was more than that of the control group, however, there was no significant difference in the total length of hospital stay between the two groups. CONCLUSION The choice of antibiotics is very limited for clinical treatment of the AB-VAP patients, and there is no significant difference between the specific risk factors for AB-VAP and the conventional VAP. It is necessary to take targeted measures for prevention of infection.

关 键 词：重症监护室 机械通气 鲍氏不动杆菌 耐药特征 危险因素 

分 类 号：R378[医药卫生—病原生物学]