鲍曼不动杆菌颅内感染死亡危险因素分析  

Analysis of risk factors of death from intracranial infection of Acinetobacter baumannii

作　　者：刘艳华[1] 肖艳萍 钟桥石[1] 曹星卫 杭亚平[1] 李福兴 胡龙华[1] LIU Yanhua;XIAO Yanping;ZHONG Qiaoshi;CAO Xingwei;HANG Yaping;LI Fuxing;HU Longhua(Department of Clinical Laboratory,the Second Affiliated Hospital of Nanchang University/Jiangxi province Key Laboratory of Laboratory Medicine,Nanchang,Jiangxi 330006,China)

机构地区：[1]南昌大学第二附属医院检验科/江西省检验医学重点实验室,江西南昌330006

出　　处：《国际检验医学杂志》2024年第S02期51-56,共6页International Journal of Laboratory Medicine

基　　金：江西省卫生健康委科技计划项目(202130412)。

摘　　要：目的探讨鲍曼不动杆菌(AB)颅内感染的临床特点和危险因素,为临床诊治提供参考依据。方法收集2017年8月至2023年6月该院收治的AB颅内感染患者的临床资料和数据,研究周期内共有75例患者入选,其中死亡29例,生存46例,分为死亡组和生存组,采用单因素和多因素Logistic回归分析AB颅内感染的危险因素。结果本研究死亡组和生存组AB菌株对头孢菌素类和碳青霉烯类抗菌药物的耐药率比较,差异有统计学意义(P<0.05),其对头孢菌素和碳青霉烯类药物耐药率最高,比例均超过60.0%,但对替加环素的耐药率最低,比例为4.0%。颅内感染碳青霉烯类耐药鲍曼不动杆菌(CRAB)临床分离率高达65.3%,菌株主要来自ICU和神经外科。碳青霉烯类敏感鲍曼不动杆菌(CSAB)组患者28d的存活率明显高于CRAB组(P<0.05);单因素分析结果发现,入住ICU、手术次数≥2次、合并高血压、低白蛋白血症、留置鼻胃管、使用碳青霉烯类药物和应用3种及以上抗菌药物为AB颅内感染的危险因素(P<0.05);多因素Logistic回归分析显示,低白蛋白血症、留置鼻胃管和应用3种及以上抗菌药物是AB颅内感染死亡的独立危险因素(P<0.05)。结论鲍曼不动杆菌颅内感染死亡与低白蛋白血症、留置鼻胃管和应用3种及以上抗菌药物等因素有关,临床应密切监测患者白蛋白水平,留置鼻胃管时应规范操作和无菌管理,同时尽可能地减少抗菌药物使用的种类和时间,对有效治疗鲍曼不动杆菌颅内感染具有重要意义。Objective To investigate the clinical characteristics and risk factors of intracranial infection of Acinetobacter baumannii(AB),and to provide reference for clinical diagnosis and treatment.Methods Clini-cal profiles and datas of patients with AB intracranial infection admitted to the hospital from August 2017 to June 2023 were collected.During the study period,a total of 75 patients were enrolled,of whom 29 died and 46 survived,and were divided into death group and survival group.Univariate and multivariate Logistic regression were used to analyze the risk factors of AB intracranial infection.Results In this study,there were statistical-ly significant differences in the resistance rate of strains to cephalosporins and carbapenems between the death group and the survival group(P<0.05).The resistance rates of Acinetobacter baumannii to cephalosporins and carbapenems were the highest,which were more than 60.0%,but the resistance rate to tigacycline was the lowest(4.0%).The isolation rate of Carbapenem-resistant Acinetobacter baumannii(CRAB)was as high as 65.3%,and the strains were mainly from ICU and neurosurgery department.The survival rate at 28 days in Carbapenem sensitive Acinetobacter baumannii(CSAB)group was significantly higher than that in CRAB group(P<0.05).The results of univariate analysis showed that ICU admission,operation frequency≥2 times,combination of hypertension,hypoproteinemia,presence of nasogastric tube,use of carbapenems and use of no less than 3 types of antibiotics were risk factors for intracranial infection of AB(P<0.05).Multivariate Logistic regression analysis showed that hypoproteinemia,presence of nasogastric tube and use of no less than 3 types of antibiotics were independent risk factors for death from intracranial infection of AB(P<0.05).Conclusion The death of Acineto-bacter baumannii intracranial infection is related to hypoalbuminemia,presence of nasogastric tube and the use of no less than 3 types of antibiotics.In clinical practice,the albumin level of the patient should be

关 键 词：鲍曼不动杆菌 颅内感染 危险因素 预后 

分 类 号：R446.5[医药卫生—诊断学]