162例急诊科多药耐药鲍氏不动杆菌感染病例临床特征及其危险因素  

Clinical characteristics and risk factors for multidrug-resistant Acinetobacter baumannii infection in 162 emergency department patients

作　　者：张玉伟 冯全胜[2] 谷优优[3] 杨明[4] 付桂 张利华 ZHANG Yu-wei;FENG Quan-sheng;GU You-you;YANG Ming;FU Gui;ZHANG Li-hua(Tianjin Fifth Central Hospital,Tianjin 300450,China;不详)

机构地区：[1]天津市第五中心医院急诊内科,天津300450 [2]天津市第三中心医院重症医学科,天津300170 [3]天津市第五中心医院内分泌科,天津300450 [4]天津市第五中心医院急诊科,天津300450

出　　处：《中华医院感染学杂志》2022年第21期3220-3223,共4页Chinese Journal of Nosocomiology

基　　金：天津市自然科学基金资助项目(19JCYBJC11240)。

摘　　要：目的研究急诊科多药耐药鲍氏不动杆菌(MDRAB)感染病例临床特征及其危险因素。方法选择2018年4月-2021年6月天津市第五中心医院急诊科收治的162例患者为研究对象,分析MDRAB感染情况,通过单因素以及Logistic多元回归分析急诊科患者发生MDRAB感染的危险因素。结果162例患者中共检测样本1068份,MDRAB病原菌31株,MDRAB感染患者24例。感染部位以呼吸道(48.39%)、泌尿道(19.35%)居多,菌株标本来源以痰液(74.19%)居多。MDRAB菌株对克拉维酸最为敏感,耐药率为45.16%,对头孢吡肟、头孢曲松敏感性最低,耐药率为80.65%。单因素及Logistic多元回归分析显示,急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)≥15分、抗菌药物种类是急诊科患者发生MDRAB感染的危险因素(P<0.05)。结论急诊科患者MDRAB感染部位以呼吸道、泌尿道居多,耐药性方面对头孢类药物敏感度较低,对克拉维酸敏感度相对较高。APACHEⅡ评分、抗菌药物种类是急诊科患者发生MDRAB感染的危险因素。OBJECTIVE To explore the characteristics and risk factors for multidrug-resistant Acinetobacter baumannii(MDRAB)infection in emergency department.METHODS A total of 162 patients who were treated in emergency department of Tianjin Fifth Central Hospital from Apr 2018 to Jun 2021 were recruited as the study objects,the prevalence of MDRAB infection was analyzed,univariate analysis and multivariate logistic regression analysis were performed for the risk factors for MDRAB infection in emergency department patients.RESULTS Totally1068 samples were collected from the 162 patients,31 strains of MDRAB were isolated,and 24 patients had MDRAB infection.48.39%of the patients had respiratory tract infection,19.35%had urinary tract infection.74.19%of the strains were isolated from sputum specimens.The MDRAB strains were most sensitive to clavulanic acid,with the drug resistance rate 45.16%;the drug resistance rate to cefepime and ceftriaxone was 80.65%.The results of univariate analysis and multivariate logistic regression analysis showed that acute physiology and chronic health Evaluation(APACHE)II score no less than 15 points and type of antibiotic were the risk factors for MDRAB infection in the patients of emergency department(P<0.05).CONCLUSION The patients with respiratory tract infection,urinary tract infection are dominant among the emergency department patients with MDRAB infection,the drug susceptibility rates of the strains to cephalosporins are low,while the drug susceptibility rate to clavulanic acid is relatively high.APACHE II score and type of antibiotic are the risk factors for the MDRAB infection in the patients of emergency department.

关 键 词：急诊科 多药耐药 鲍氏不动杆菌 感染 LOGISTIC回归 

分 类 号：R181.3[医药卫生—流行病学]