亚胺培南耐药鲍曼不动杆菌医院获得性肺炎的危险因素及耐药性分析

发布时间：2018-10-10 11:50

【摘要】：目的探讨浙江大学附属第一医院亚胺培南耐药鲍曼不动杆菌(IRAB)引起医院获得性肺炎(HAP)的危险因素及预后,并了解该院IRAB的耐药情况。方法回顾性分析该院2011年1月至2012年12月收治的201例鲍曼不动杆菌医院获得性肺炎患者的临床资料,其中IRAB组155例,亚胺培南敏感(ISAB)组46例,两组间采取单因素分析及多因素Logistic回归分析,分析IRAB HAP发生的危险因素,并分析IRAB对其他16种抗菌药物的耐药情况,比较两组患者30天病死率。结果单因素分析发现:入住ICU、昏迷、气管插管/切开、机械通气、留置胃管、糖皮质激素使用≥1周、2种及以上抗生素联用、分离出AB前28天内碳青霉烯类抗生素使用、低白蛋白血症、入院时APACHE II评分≥20分与IRAB HAP发生显著相关,多因素Logistic回归分析发现:分离出AB前28天内碳青霉烯类抗生素使用、入院时APACHE II评分≥20分是IRAB HAP发生的独立危险因素;而IRAB仅对阿米卡星耐药率较低(38.7%),对头孢哌酮舒巴坦耐药率高达64.5%,且对比ISAB,IRAB对大部分抗菌药物耐药率均明显上升,IRAB组患者死亡率明显上升。结论分离出AB前28天内碳青霉烯类抗生素使用、入院时APACHE II评分≥20分是IRAB HAP发生的危险因素,IRAB耐药情况极其严重,均为多重耐药菌株,IRAB HAP患者预后差,死亡率高。
[Abstract]:Objective to investigate the risk factors and prognosis of nosocomial pneumonia (HAP) caused by acinetobacter baumannii (IRAB) in the first affiliated Hospital of Zhejiang University, and to understand the drug resistance of IRAB in this hospital. Methods the clinical data of 201 patients with Acinetobacter baumannii nosocomial pneumonia from January 2011 to December 2012 were retrospectively analyzed, including 155 cases in IRAB group and 46 cases in imipenem sensitive (ISAB) group. Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of IRAB HAP and to analyze the drug resistance of IRAB to other 16 antimicrobial agents. The 30-day mortality of the two groups was compared. Results univariate analysis showed that ICU, coma, tracheal intubation / incision, mechanical ventilation, indwelling gastric tube, glucocorticoid use 鈮，

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