重症监护病房患者多重耐药鲍曼不动杆菌感染及 病死危险因素分析

目的探讨重症监护病房患者多重耐药鲍曼不动杆菌(MDRAb)感染的危险因素及MDRAb感染患者病死的危险因素,为防治MDRAb提供依据。方法回顾性分析2014年1月至2017年10月遂宁市中心医院重症监护病房197例鲍曼不动杆菌(Ab)感染患者,采用病例对照研究,根据抗生素敏感实验结果,将111例MDRAb感染者作为病例组,86例非MDRAb感染者作为对照组,收集其人口学资料、感染前的临床资料和实验室数据,应用单因素分析及多因素Logistic回归分析其感染的危险因素。同时将病例组分为病死组与存活组,分析其病死危险因素。结果 MDRAb检出率为56.35%。单因素Logistic分析显示,ICU停留时间、使用抗生素7d、使用喹诺酮类抗生素、有创通气和胃管插管可能是MDRAb感染的危险因素(P0.05)。多因素Logistic回归分析显示,使用抗生素7d(OR=2.338,95%CI:1.252~4.368)、使用喹诺酮类抗生素(OR=3.703,95%CI:1.665~8.234)、有创通气(OR=4.356,95%CI:1.695~11.192)是MDRAb感染的独立危险因素。单因素Logistic分析显示,年龄、高血压、血红蛋白量、昏迷可能是MDRAb感染患者病死的危险因素。多因素Logistic回归分析显示,高血压(OR=5.185,95%CI:2.012~13.361)、血红蛋白量(OR=0.976,95%CI:0.957~0.996)和昏迷(OR=4.061,95%CI:1.517~10.873)是MDRAb感染患者病死的独立危险因素。结论使用抗生素7d、使用喹诺酮类抗生素、有创通气是MDRAb感染的独立危险因素;高血压、血红蛋白量、昏迷是MDRAb感染患者病死的危险因素。

Risk factors of multidrug resistant Acinetobacter baumannii infection and mortality of patients in intensive care unit

Abstract: Objective To discuss the risk factors of multiple drug resistant Acinetobacter baumannii (MDRAb) infection and of mortality of the patients in intensive care unit (ICU), so as to provide references for clinical prevention and treatment. Methods A case-control study was conducted on the data (including the demographic, clinical and laboratory data) of 197 patients with Ab infection, who were treated in ICU from January 2014 to October 2017. Univariate and multivariate Logistic analyses were performed to examine the risk factors of the infection and mortality. Results The detection rate of MDRAb was 56.35%. Univariate analysis showed that the risk factors for MDRAB infection included ICU length of stay, antibiotic use > 7 days, use of Quinolones, invasive ventilation and gastric tube (P<0.05). Multivariate Logistic analysis showed that antibiotic use > 7 days (OR=2.338, 95%CI: 1.252 - 4.368), use of Quinolones (OR=3.703, 95%CI: 1.665 - 8.234) and invasive ventilation (OR=4.356, 95%CI: 1.695 - 11.192) were the independent risk factors of MDRAb infection. Univariate analysis showed that the risk factors of mortality in patients with MDRAb infection were possibly age, hypertension, hemoglobin and coma. Multivariate Logistic analysis showed that hypertension (OR=5.185, 95%CI: 2.012 - 13.361), hemoglobin (OR=0.976, 95%CI: 0.957 - 0.996) and coma (OR=4.061, 95%CI: 1.517 - 10.873) were the independent risk factors. Conclusion ICU length of stay, use of Quinolones and invasive ventilation were the independent risk factors for MDRAb infection. Hypertension hemoglobin and coma were the risk factors for death in MDRAb infections.