CAJ | 학술논문

目的调查儿童重症监护病房(PICU)多重耐药鲍氏不动杆菌(MDRAb)肺部感染危险因素及药物敏感性,为减少MDRAb感染发生及有效治疗提供帮助.方法以45例非MDRAb肺部感染患儿(NMDRAb组)为对照,回顾性分析2009年1月至2011年8月武汉市儿童医院PICU收治的115例MDRAb肺部感染(MDRAb组)药敏结果,采用单因素和多因素Logistic回归分析方法,分析各研究因素与MDRAb感染关系,找出感染危险因素.结果共检出Ab 176株,其中MDRAb 128株,占72.73％.药敏结果显示,除头孢哌酮/舒巴坦外,其他β-内酰胺类药物耐药率均＞70％,碳青霉烯类药物耐药率高达90％以上,普遍高于NMDRAb感染组,阿米卡星、环丙沙星、左旋氧氟沙星及米诺环素耐药率最低(＜20％)；多因素Logistic回归分析显示ICU入住时间、机械通气时间、贫血、低蛋白血症、前期碳青霉烯类抗生素的使用为MDRAb肺部感染独立危险因素.结论 MDRAb是PICU肺部感染的重要条件致病菌,耐药现象严重,严重影响患儿预后,针对感染相关危险因素,积极采取行之有效的预防措施是降低其发生率的关键.
목적 조사인동중증감호병방(PICU)다중내약포씨불동간균(MDRAb)폐부감염위험인소급약물민감성,위감소MDRAb감염발생급유효치료제공방조.방법 이45례비MDRAb폐부감염환인(NMDRAb조)위대조,회고성분석2009년1월지2011년8월무한시인동의원PICU수치적115례MDRAb폐부감염(MDRAb조)약민결과,채용단인소화다인소Logistic회귀분석방법,분석각연구인소여MDRAb감염관계,조출감염위험인소.결과 공검출Ab 176주,기중MDRAb 128주,점72.73％.약민결과현시,제두포고동/서파탄외,기타β-내선알류약물내약솔균＞70％,탄청매희류약물내약솔고체90％이상,보편고우NMDRAb감염조,아미잡성、배병사성、좌선양불사성급미낙배소내약솔최저(＜20％)；다인소Logistic회귀분석현시ICU입주시간、궤계통기시간、빈혈、저단백혈증、전기탄청매희류항생소적사용위MDRAb폐부감염독립위험인소.결론 MDRAb시PICU폐부감염적중요조건치병균,내약현상엄중,엄중영향환인예후,침대감염상관위험인소,적겁채취행지유효적예방조시시강저기발생솔적관건.
Objective To investigate the risk factors involved in the refractory pneumonia caused by multidrug resistant acinetobacter baumannii (MDRAb) in pediatric Intensive care unit (PICU).Methods From January 2009 to August 2011,115 patients with MDRAb pneumonia were treated in Department of Emergency,Wuhan Children's Hospital,Wuhan.Another 45 patients with negative MDRAb (NMDRAb)pneumonia served as control.The patients in the two goups were analyzed using univariate and multivariate Logistic regression to find out the risk factors for MDRAb infection.Results Among the 176 clinical strains of acinetobacter baumannii isolated,128 (72.73％) strains were MDRAb.After drug susceptibility tests,acinetobacter baumannii showed the rates of resistance to β-lactams antibiotics not including cefoperazone-sulbactam were more than 70％,and the rates of resistance to carbapenems antibiotics were higher than 90％.All rates of resistance to antibiotics of betalactams and carbapenems in MDRAb were higher than those in NMDRAb significantly.There were very low rates of drug-resistance found in Amikacin,Levofloxacin,Ciprofloxacin and Minocycline ( ＜20％ ).Multivariate logistic regression revealed that ICU stay,length of time for mechanical ventilation,anemia,hypoproteinemia and the use of carbapenems were independent risk factors involved in MDRAb pneumonia.Conclusions MDRAb was an important conditional pathogen with high rate of drug-resistance to many antibiotics leading to pneumonia in PICU.It increased the mortality of patients significantly.To control the infection of MDRAb was the key to increasing efficacy of treatment of pneumonia in PCIU.