中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2014年
5期
401-404
,共4页
陆坤%李静%李金%田彬%李妍淳%胡志东
陸坤%李靜%李金%田彬%李妍淳%鬍誌東
륙곤%리정%리금%전빈%리연순%호지동
鲍氏不动杆菌%危险因素%抗药性%血流感染%急性生理学与慢性健康状况评分系统Ⅱ
鮑氏不動桿菌%危險因素%抗藥性%血流感染%急性生理學與慢性健康狀況評分繫統Ⅱ
포씨불동간균%위험인소%항약성%혈류감염%급성생이학여만성건강상황평분계통Ⅱ
Acinetobacter baumannii%Risk factors%Drug resistance%Bloodstream infection%Acute physiology and chronic health evaluation Ⅱ
目的 探讨影响鲍曼不动杆菌血流感染预后的危险因素及菌株耐药情况.方法 回顾性分析2011年1月至2014年5月天津医科大学总医院80例血流感染鲍曼不动杆菌住院患者的资料,包括年龄、性别、入住科室、基础疾病、治疗、有创操作、细菌耐药性和入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分.采用多因素Logistic回归分析影响预后的相关因素.结果 80株鲍曼不动杆菌对头孢他啶、头孢曲松,头孢西丁的耐药率高达90％以上,对亚胺培南的耐药率为66.3％,对头孢哌酮/舒巴坦以及替加环素的耐药率较低,分别为7.5％和2.5％.入住ICU[优势比(OR)=6.67,95％可信区间(95％ CI)为2.01 ～ 22.07,P＜0.01],多重耐药(OR=3.55,95％ CI为1.30～9.69,P＜0.05),APACHEⅡ评分≥19(OR=39.00,95％ CI为9.87 ～ 154.09,P＜0.01),动脉插管(OR=3.24,95％ CI为1.16～9.04,P＜0.05),中央静脉插管(OR=3.33,95％ CI为1.22 ～9.12,P＜0.05),气管插管(OR=3.60,95％ CI为1.31 ～9.88,P＜0.05),气管切开(OR =3.21,95％ CI为1.19 ～8.66,P＜0.05),其他有创操作(OR =3.00,95％ CI为1.11～ 8.08,P＜0.05)为鲍曼不动杆菌血流感染患者死亡的危险因素.结论 侵入性操作与细菌的耐药性会增加鲍曼不动杆菌血流感染患者的病死率.
目的 探討影響鮑曼不動桿菌血流感染預後的危險因素及菌株耐藥情況.方法 迴顧性分析2011年1月至2014年5月天津醫科大學總醫院80例血流感染鮑曼不動桿菌住院患者的資料,包括年齡、性彆、入住科室、基礎疾病、治療、有創操作、細菌耐藥性和入院時急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分.採用多因素Logistic迴歸分析影響預後的相關因素.結果 80株鮑曼不動桿菌對頭孢他啶、頭孢麯鬆,頭孢西丁的耐藥率高達90％以上,對亞胺培南的耐藥率為66.3％,對頭孢哌酮/舒巴坦以及替加環素的耐藥率較低,分彆為7.5％和2.5％.入住ICU[優勢比(OR)=6.67,95％可信區間(95％ CI)為2.01 ～ 22.07,P＜0.01],多重耐藥(OR=3.55,95％ CI為1.30～9.69,P＜0.05),APACHEⅡ評分≥19(OR=39.00,95％ CI為9.87 ～ 154.09,P＜0.01),動脈插管(OR=3.24,95％ CI為1.16～9.04,P＜0.05),中央靜脈插管(OR=3.33,95％ CI為1.22 ～9.12,P＜0.05),氣管插管(OR=3.60,95％ CI為1.31 ～9.88,P＜0.05),氣管切開(OR =3.21,95％ CI為1.19 ～8.66,P＜0.05),其他有創操作(OR =3.00,95％ CI為1.11～ 8.08,P＜0.05)為鮑曼不動桿菌血流感染患者死亡的危險因素.結論 侵入性操作與細菌的耐藥性會增加鮑曼不動桿菌血流感染患者的病死率.
목적 탐토영향포만불동간균혈류감염예후적위험인소급균주내약정황.방법 회고성분석2011년1월지2014년5월천진의과대학총의원80례혈류감염포만불동간균주원환자적자료,포괄년령、성별、입주과실、기출질병、치료、유창조작、세균내약성화입원시급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분.채용다인소Logistic회귀분석영향예후적상관인소.결과 80주포만불동간균대두포타정、두포곡송,두포서정적내약솔고체90％이상,대아알배남적내약솔위66.3％,대두포고동/서파탄이급체가배소적내약솔교저,분별위7.5％화2.5％.입주ICU[우세비(OR)=6.67,95％가신구간(95％ CI)위2.01 ～ 22.07,P＜0.01],다중내약(OR=3.55,95％ CI위1.30～9.69,P＜0.05),APACHEⅡ평분≥19(OR=39.00,95％ CI위9.87 ～ 154.09,P＜0.01),동맥삽관(OR=3.24,95％ CI위1.16～9.04,P＜0.05),중앙정맥삽관(OR=3.33,95％ CI위1.22 ～9.12,P＜0.05),기관삽관(OR=3.60,95％ CI위1.31 ～9.88,P＜0.05),기관절개(OR =3.21,95％ CI위1.19 ～8.66,P＜0.05),기타유창조작(OR =3.00,95％ CI위1.11～ 8.08,P＜0.05)위포만불동간균혈류감염환자사망적위험인소.결론 침입성조작여세균적내약성회증가포만불동간균혈류감염환자적병사솔.
Objective To investigate the antibiotic resistance of Acinetobacter baumannii,and to identify the risk factors for fatality of Acinetobacter baumannii bloodstream infection.Methods A retrospective review was conducted on 80 patients with Acinetobacter baumannii bloodstream infections admitted in Tianjin General Hospital during January 2011 to May 2014.Clinical data including demographic information,the ward of stay,underlying diseases,treatment,invasive procedures,antibiotic resistance,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at admission were collected.Multivariate Logistic regression analysis was performed to identify the risk factors for fatality.Results There were ≥90％ strains resistant to ceftazidime,ceftriaxone and cefoxitin,and 66.3％ strains were resistant to imipenem.While most strains were sensitive to cefoperazone/shubatan and tigecycline,and the resistance rates were 7.5％ and 2.5％,respectively.ICU admission (OR =6.67,95％ CI:2.01-22.07,P ＜0.01),multi-drug resistance (OR =3.55,95％ CI:1.30-9.69,P ＜ 0.05),APACHE Ⅱ score ≥ 19 (OR =39.00,95％ CI:9.87-154.09,P ＜ 0.01),artery catheterization (OR =3.24,95％ CI:1.16-9.04,P ＜ 0.05),central venous catheterization (OR =3.33,95％ CI:1.22-9.12,P ＜ 0.05),tracheal catheterization (OR=3.60,95％CI:1.31-9.88,P＜0.05),tracheostomy (OR=3.21,95％CI:1.19-8.66,P＜0.05),and other invasive procedures (OR =3.00,95％ CI:1.11-8.08,P ＜ 0.05) were the risk factors for fatality.Conclusion Invasive procedures and multi-drug resistance are associated with increased fatality of patients with Acinetobacter baumannii bloodstream infection.
