CAJ | 학술논문

目的:分析2007年1月至2008年3月北京大学第三医院临床分离的耐碳青霉烯鲍曼不动杆菌的同源性,调查其定植或感染的危险因素,评价该菌所致医疗相关性感染的抗菌药物治疗.方法:通过复习病历收集耐碳青霉烯鲍曼不动杆菌定植或感染患者的临床资料.菌株的药敏试验采用纸片法,通过脉冲场凝胶电泳分析菌株的同源性.结果:研究期间共分离到49株耐碳青霉烯鲍曼不动杆菌菌株,其脉冲场凝胶电泳分型为7型,共45株(91.8%)具有同源性.分离到菌株前患者最常见的暴露因素为住ICU、侵入性操作和低白蛋白血症,最常见的合并症是慢性阻塞性肺疾病(12例)和脑血管病(10例).在这49株菌中,定植者28株,导致感染者21株,感染患者的死亡率为38.1%.Logistic回归分析发现APACHEⅡ评分是导致死亡的独立危险因素(P=0.02,OR=1.7,95%CI1.1～2.5).抗菌药物联合治疗的成功率高于单药治疗(11/13例,84.6%vs.3/17例,17.6%),尤其是头孢哌酮/舒巴坦联合左氧氟沙星联合治疗.结论:我院自2007年出现了耐碳青霉烯鲍曼不动杆菌菌株的院内播散,导致播散的危险因素为住ICU、侵入性操作、低白蛋白血症、慢性阻塞性肺疾病和脑血管病,对耐碳青霉烯鲍曼不动杆菌感染,抗菌药物联合治疗可能优于单药治疗.
목적:분석2007년1월지2008년3월북경대학제삼의원림상분리적내탄청매희포만불동간균적동원성,조사기정식혹감염적위험인소,평개해균소치의료상관성감염적항균약물치료.방법:통과복습병력수집내탄청매희포만불동간균정식혹감염환자적림상자료.균주적약민시험채용지편법,통과맥충장응효전영분석균주적동원성.결과:연구기간공분리도49주내탄청매희포만불동간균균주,기맥충장응효전영분형위7형,공45주(91.8%)구유동원성.분리도균주전환자최상견적폭로인소위주ICU、침입성조작화저백단백혈증,최상견적합병증시만성조새성폐질병(12례)화뇌혈관병(10례).재저49주균중,정식자28주,도치감염자21주,감염환자적사망솔위38.1%.Logistic회귀분석발현APACHEⅡ평분시도치사망적독립위험인소(P=0.02,OR=1.7,95%CI1.1～2.5).항균약물연합치료적성공솔고우단약치료(11/13례,84.6%vs.3/17례,17.6%),우기시두포고동/서파탄연합좌양불사성연합치료.결론:아원자2007년출현료내탄청매희포만불동간균균주적원내파산,도치파산적위험인소위주ICU、침입성조작、저백단백혈증、만성조새성폐질병화뇌혈관병,대내탄청매희포만불동간균감염,항균약물연합치료가능우우단약치료.
Objective:To assess the genetic relationship of clinical isolates of carbapenem-resistant A.baumannii (resistant to both imipenem and meropenem) from January 2007 to March 2008 in Peking University Third Hospital for measures to decrease the isolates; to investigate the characteristics of patients with carbapenem-resistant A. baumannii colonization or infection and to evaluate antibiotic treatment for health care-associated infections caused by carbapenem-resistant A. baumannii. Methods: The medical records of patients with carbapenem-resistant A. baumannii colonization or infection were reviewed. Antibiotic susceptibilities of the isolates were determined by the standardized disk-diffusion method and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis. Results: A total of 49 carbapenem-resistant A. baumannii strains were isolated from the 49 patients hospitalized during the study period and pulsed-field gel electrophoresis typing yielded 7 different patterns. A total of 45 (91.8%)genotyped strains showed clonal relationship. The most frequently identified predisposing factors were intensive care unit stay, invasive procedures, and hypoalbuminemia. Chronic obstructive pulmonary disease (12 cases) and cerebrovascular disease (10 cases) were the most common comorbid conditions.The mortality of patients with carbapenem-resistant A. baumannii infection was 38. 1% (8 of 21 patients), and the acute physiology and chronic health evaluation Ⅱ score, initial antibiotic therapy failure rate and the presence of hypoalbuminemia were significantly increased in the death group. Combination therapy regimens had higher success rates than monotherapy regimens (11/13, 84. 6% vs. 3/17,17.6%). Conclusion: There has been clonal spread of carbapenem-resistant A. baumannii strains among patients in our hospital since 2007. Intensive care unit stay, invasive procedures, hypoalbuminemia, chronic obstructive pulmonary disease and cerebrovascular disease were common in patients with carbapenem-resistant A. baumannii colonization or infection. Antibiotic combination therapy may be effective for carbapenem-resistant A. baumannii infection.