CAJ | 학술논문

目的：探讨 ICU 泛耐药鲍曼不动杆菌肺炎患者的危险因素，为临床区分感染与定植提供参考和依据。方法回顾性调查广东省中医院芳村医院2009年2月-2012年3月重症监护室（ICU）鲍曼不动杆菌肺炎患者99例，对引起泛耐药发生的相关因素进行多因素 Logistic 回归分析。结果入住 ICU 时间，有创通气时间，使用碳青霉烯类、β内酰胺类-β内酰胺酶抑制剂合剂、喹诺酮类抗菌药物的时间，使用抗菌药物3种以上，进行3种以上侵袭性操作（包括留置胃管、导尿管、深静脉管、动脉导管），纤维支气管镜治疗与泛耐药鲍曼不动杆菌感染有关（P ＜0．05）。Logistic 回归分析发现，抗菌药物种类数目、纤维支气管镜治疗及β内酰胺类-β内酰胺酶抑制剂合剂使用天数为独立危险因素。结论临床治疗时，应结合危险因素，区分感染还是定植，以采取相应防治措施。
목적：탐토 ICU 범내약포만불동간균폐염환자적위험인소，위림상구분감염여정식제공삼고화의거。방법회고성조사광동성중의원방촌의원2009년2월-2012년3월중증감호실（ICU）포만불동간균폐염환자99례，대인기범내약발생적상관인소진행다인소 Logistic 회귀분석。결과입주 ICU 시간，유창통기시간，사용탄청매희류、β내선알류-β내선알매억제제합제、규낙동류항균약물적시간，사용항균약물3충이상，진행3충이상침습성조작（포괄류치위관、도뇨관、심정맥관、동맥도관），섬유지기관경치료여범내약포만불동간균감염유관（P ＜0．05）。Logistic 회귀분석발현，항균약물충류수목、섬유지기관경치료급β내선알류-β내선알매억제제합제사용천수위독립위험인소。결론림상치료시，응결합위험인소，구분감염환시정식，이채취상응방치조시。
Objective To investigate the risk factor profile of pneumonia caused by pandrug-resistant Acinetobacter baumannii (PDRAB)in intensive care unit for better distinction between PDRAB infection and colonization.Methods The clinical data of 99 patients diagnosed as A.baumannii pneumonia between February 2009 and March 2012 in Fangcun Hospital,a branch of Guangdong Provincial Hospital of Traditional Chinese Medicine,were reviewed and analyzed retrospectively.The risk factors associated with pandrug-resistance in A.baumannii were examined with multivariate logistic regression analysis.Results ICU stay,duration of invasive ventilation,longer duration of treatment with carbapenems,beta-lactam/beta-lactamase inhibitor,or quinolone antibiotics,use of ≥3 classes of antimicrobial agents,≥3 invasive procedures (including indwelling gastric canal, catheterization,central venous catheter,arterial sheath),and fiberoptic bronchoscopic treatment were associated with PDRAB pneumonia (P <0.05).Multivariate logistic regression analysis showed that use of ≥3 classes of antibiotics,fiberoptic bron-choscopic treatment,and longer duration of treatment with beta-lactam/beta-lactamase inhibitor were independent risk factors predicting the emergence of PDRAB pneumonia.Conclusions We should pay more attention to these risk factors in clinical prac-tice for better differentiation between PDRAB infection and colonization so that appropriate control measures can be taken pro-actively.