鲍曼不动杆菌血流感染患者死亡危险因素及流行特征分析

发布时间：2018-01-06 19:25

本文关键词：鲍曼不动杆菌血流感染患者死亡危险因素及流行特征分析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对43例鲍曼不动杆菌血流感染住院患者的病例资料进行回顾性分析,明确鲍曼不动杆菌血流感染的预后及影响预后的主要危险因素。同时通过脉冲场凝胶电泳技术(PFGE,Pulsed-field Gel Electrophoresis)分析鲍曼不动杆菌的流行特征。方法:对2013年1月至2016年5月期间浙江大学医学院附属邵逸夫医院43例鲍曼不动杆菌血流感染住院患者的病例资料进行回顾性分析,统计人口学资料、基础疾病、侵入性操作及手术、入住ICU、细菌耐药性等。根据患者28d预后分为死亡组与存活组,通过多因素Logistic回归分析死亡独立危险因素,并通过脉冲场凝胶电泳技术(PFGE,Pulsed-field Gel Electrophoresis)分析鲍曼不动杆菌的流行特征。结果:43例鲍曼不动杆菌血流感染患者中,存活组25例,死亡组18例,28天病死率为41.9%。单因素分析显示,死亡组患者的年龄高于存活组[(69.8±14.8)岁vs.(59.1±14.9)岁;P0.05],但死亡组的住院天数少于存活组[(24.0±15.5)天vs.(46.6±35.3)天;P0.05];入住ICU比例、气管插管、血透管置入、PICCO等比例均多于存活组(94.4%vs.56%;88.9%vs.32.0%;66.7%vs.20.0%;38.9%vs.8%,P均0.05),但在多因素回归分析中未发现具有统计学意义的独立危险因素。本研究中鲍曼不动杆菌血流感染患者主要住在ICU(占所有病人的72.1%),多因素logistic回归分析显示,性别(女性患者)(OR=0.167,95%CI0.023～0.956,P0.05)和感染性休克(OR=05.24,95%CI0.997～46.955,P0.05)为入住ICU的鲍曼不动杆菌血流感染患者死亡的独立危险因素。PFGE图谱有14个类型,根据同源性可分为14个克隆。其中最多类型的有12株细菌(27.9%),主要分布在ICU(9株)和普外科(3株)。结论:鲍曼不动杆菌引起的血流感染的病死率为41.9%,女性患者和感染性休克为入住ICU的鲍曼不动杆菌血流感染患者死亡的独立危险因素。鲍曼不动杆菌在ICU内部及ICU与各病区之间存在交叉传播,这种病区间的交叉传播主要是通过病人在ICU和病房之间的转运实现的。
[Abstract]:Objective: to analyze retrospectively the data of 43 inpatients with Acinetobacter baumannii hemodynamics infection. To determine the prognosis of Acinetobacter baumannii blood stream infection and the main risk factors affecting prognosis. At the same time, PFGE was detected by pulsed field gel electrophoresis. Pulsed-field Gel Electrophoresis. The epidemic characteristics of Acinetobacter baumannii were analyzed. From January 2013 to May 2016, the data of 43 patients with Acinetobacter baumannii blood stream infection in run run run Shaw Hospital, Zhejiang University Medical College, were retrospectively analyzed. Statistical demographic data, basic diseases, invasive operation and surgery, ICU, bacterial resistance, etc. were divided into death group and survival group according to the prognosis of 28 days. The risk factors of death were analyzed by multivariate Logistic regression analysis and pulsed field gel electrophoresis. The epidemic characteristics of Acinetobacter baumannii were analyzed by Pulsed-field Gel Electrophoresis.Results in 43 patients with blood stream infection of Acinetobacter baumannii. There were 25 cases in survival group and 18 cases in death group. The fatality rate of 28 days was 41.9%. Univariate analysis showed that the age of death group was higher than that of survival group. [69.8 卤14.8 years old vs.(59.1 卤14.9 years old, but the days of hospitalization in the death group were less than those in the survival group. [24. 0 卤15. 5 days vs.(46.6 卤35. 3 days; P0.05]; The proportion of admission to ICU, tracheal intubation and hemodialysis tube placement were higher than those of survival group (94. 4 vs 56). 88.9 vs. 32.0; 66.7s. 20.0; 38.9% vs.8s. 0. 05). However, no statistically significant independent risk factors were found in multivariate regression analysis. In this study, patients with Acinetobacter baumannii bloodstream infection mainly lived in ICU (72.1% of all patients). Multivariate logistic regression analysis showed that the sex (female patients) was 0.167% 95% CI 0.023 ~ 0.956. P0.05) and septic shock 05.24595 CI0.997 + 46.955. P0.05) an independent risk factor for death in patients with blood stream infection of Acinetobacter baumannii admitted to ICU. According to the homology, there are 14 clones. Among them, 12 strains of bacteria have the most types. Conclusion: the mortality of blood stream infection caused by Acinetobacter baumannii is 41.9%. Female patients and septic shock were independent risk factors of death in patients with blood stream infection of Acinetobacter baumannii admitted to ICU. Acinetobacter baumannii was cross-transmitted within ICU and between ICU and different areas. The cross-spread of the disease occurs mainly through the transport of patients between the ICU and the ward.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R516

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