鲍曼不动杆菌无菌体液感染患者归因危险度多中心回顾性队列研究  

A multicenter retrospective cohort study on the attributable risk of patients with Acinetobacter baumannii sterile body fluid infection

作　　者：何磊 姜道彬 刘丁 郑小芳 邱荷语 吴淑梅 吴晓英[4] 崔金兰 谢首佳 夏琴 何莉[8] 刘晞照 舒昌惠 李荣琴[11] 陶红英 陈泽芬 HE Lei;JIANG Dao-bin;LIU Ding;ZHENG Xiao-fang;QIU He-yu;WU Shu-mei;WU Xiao-ying;CUI Jin-lan;XIE Shou-jia;XIA Qin;HE Li;LIU Xi-zhao;SHU Chang-hui;LI Rong-qin;TAO Hong-ying;CHEN Ze-fen(Department of Infection Control,The People’s Hospital of Dazu,Chonging 402360,China;Department of Disease Prevention and Control,Army Medical Center,Army Medical University,Chongqing 400042,China;Department of Infection Management,Chongqing University Fuling Hospital,Chongqing 408099,China;Department of Infection Management,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;Department of Infection Management,People’s Hospital of Xiushan County,Chongqing 409999,China;Department of Infection Management,The People’s Hospital of Kaizhou District,Chongqing 405400,China;Department of Infection,The People’s Hosptital of Nanchuan,Chongqing 408400,China;Department of Infection Management,Pujiang People’s Hospital,Chengdu 611630,China;Department of Infection Management,Chongqing University Three Gorges Hospital,Chongqing 404000,China;Department of Infection Management,The People’s Hospital of Bishan,Chongqing 402760,China;Department of Infection Management,The People’s Hospital of Qijiang,Chongqing 401420,China;Department of Infection Management,People’s Hospital of Changshou Chongqing,Chongqing 401220,China;Department of Infection Management,Chongqing University Jiangjin Hospital,Chongqing 402260,China)

机构地区：[1]重庆市大足区人民医院感染控制科,重庆402360 [2]陆军军医大学陆军特色医学中心疾病预防控制科,重庆400042 [3]重庆大学附属涪陵医院感染管理科,重庆408099 [4]重庆医科大学附属永川医院感染管理科,重庆402160 [5]重庆市秀山县人民医院感染管理科,重庆409999 [6]重庆市开州区人民医院感染管理科,重庆405400 [7]重庆市南川区人民医院院感科,重庆408400 [8]成都市蒲江县人民医院感染管理科,四川成都611630 [9]重庆大学附属三峡医院感染管理科,重庆404000 [10]重庆市璧山区人民医院感染管理科,重庆402760 [11]重庆市綦江区人民医院感染管理科,重庆401420 [12]重庆市长寿区人民医院感染管理科,重庆401220 [13]重庆大学附属江津医院感染管理科,重庆402260

出　　处：《中国感染控制杂志》2024年第1期42-48,共7页Chinese Journal of Infection Control

基　　金：重庆市卫生计生委重点项目(20141024)。

摘　　要：目的调查重症患者感染鲍曼不动杆菌(AB)后的归因危险度(AR)。方法围绕成人重症监护病房(ICU)患者开展多中心回顾性队列研究。以各中心从无菌体液中分离出AB且确认AB感染患者为感染组,以同期、同一ICU、相似的急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分(±5分)和入住ICU的主要诊断为匹配条件,按1∶2比例选取未感染AB患者作为非感染组,计算AR。结果AB无菌体液感染患者住院病死率为33.3%,非感染组患者为23.1%,两组数据比较,差异无统计学意义(P=0.069),AR为10.2%(95%CI:-2.3%~22.8%)。血、脑脊液等标本来源的感染组和非感染组患者病死率比较,差异无统计学意义(P>0.05)。主要诊断为肺部感染的重症患者感染AB后AR最高,但感染组和非感染组患者病死率比较,差异无统计学意义(P>0.05),其他诊断分类同样如此。结论重症患者AB感染预后被严重高估,但ICU仍应针对AB进行积极医院感染控制。Objective To investigate the attributable risk(AR)of Acinetobacter baumannii(AB)infection in criti-cally ill patients.Methods A multicenter retrospective cohort study was conducted among adult patients in intensive care unit(ICU).Patients with AB isolated from sterile body fluid and confirmed with AB infection in each center were selected as the infected group.According to the matching criteria that patients should be from the same period,in the same ICU,as well as with similar APACHEⅡscore(±5 points)and primary diagnosis,patients who did not infect with AB were selected as the non-infected group in a 1∶2 ratio.The AR was calculated.Results The in-hospital mortality of patients with AB infection in sterile body fluid was 33.3%,and that of non-infected group was 23.1%,with no statistically significant difference between the two groups(P=0.069).The AR was 10.2%(95%CI:-2.3%-22.8%).There is no statistically significant difference in mortality between non-infected patients and infected patients from whose blood,cerebrospinal fluid and other specimen sources AB were isolated(P>0.05).After infected with AB,critically ill patients with the major diagnosis of pulmonary infection had the highest AR.There was no statistically significant difference in mortality between patients in the infected and non-infected groups(P>0.05),or between other diagnostic classifications.Conclusion The prognosis of AB infection in critically ill patients is highly overestimated,but active healthcare-associated infection control for AB in the ICU should still be carried out.

关 键 词：鲍曼不动杆菌 归因危险度 预后 无菌体液 血 多中心队列研究 

分 类 号：R181.32[医药卫生—流行病学] R378[医药卫生—公共卫生与预防医学]