CAJ | 학술논문

目的：分析呼吸重症监护病房中患者下呼吸道感染鲍曼不动杆菌的耐药性、与患者临床特点的关系，以及对预后的影响。方法选取2012年8月至2014年2月河北医科大学第二医院呼吸重症监护病房（RIC U ）出院患者中下呼吸道感染鲍曼不动杆菌的患者，对分离的鲍曼不动杆菌菌株及其药敏结果、患者病历资料以及转归进行回顾性分析，探讨感染多重耐药鲍曼不动杆菌（MDRAb）的临床危险因素及其对预后的影响。结果研究期间共有357例患者出院，61例患者下呼吸道感染鲍曼不动杆菌（61／357，17．1％），其中MDRAb患者51例（51／61，83．6％），非MDRAb患者10例（10／61，16．4％）；共有264株鲍曼不动杆菌菌株分离培养并进行药敏试验，MDRAb检出率较高，为90．1％（238／264），非MDRAb仅26株，仅占9．9％；鲍曼不动杆菌对常用抗不动杆菌药物耐药率分别为亚胺培南97．0％（256／264）、美罗培南97．0％（256／264）、头孢哌酮‐舒巴坦93．9％（248／264）、左氧氟沙星97．3％（257／264）和阿米卡星68．2％（180／264）。 MDRAb感染患者相对于非 MDRAb患者呼吸衰竭发生率高（74．5％ vs 40．0％，P ＜0．05）；人工气道使用率高（72．5％ vs 40．0％，P ＜0．05）；感染相关的器官衰竭（SOFA）评分高（9．73±2．88 vs 7．80±2．04，P＜0．05）；死亡率高（43．1％ vs 10．0％，P＜0．05）。结论 ICU感染的MDRAb对常用抗生素耐药严重，下呼吸道MDRAb感染多见于呼吸衰竭、建立人工气道、SOFA评分更高的患者；下呼吸道MDRAb感染患者较非MDRAb感染患者病死率高。
목적：분석호흡중증감호병방중환자하호흡도감염포만불동간균적내약성、여환자림상특점적관계，이급대예후적영향。방법선취2012년8월지2014년2월하북의과대학제이의원호흡중증감호병방（RIC U ）출원환자중하호흡도감염포만불동간균적환자，대분리적포만불동간균균주급기약민결과、환자병력자료이급전귀진행회고성분석，탐토감염다중내약포만불동간균（MDRAb）적림상위험인소급기대예후적영향。결과연구기간공유357례환자출원，61례환자하호흡도감염포만불동간균（61／357，17．1％），기중MDRAb환자51례（51／61，83．6％），비MDRAb환자10례（10／61，16．4％）；공유264주포만불동간균균주분리배양병진행약민시험，MDRAb검출솔교고，위90．1％（238／264），비MDRAb부26주，부점9．9％；포만불동간균대상용항불동간균약물내약솔분별위아알배남97．0％（256／264）、미라배남97．0％（256／264）、두포고동‐서파탄93．9％（248／264）、좌양불사성97．3％（257／264）화아미잡성68．2％（180／264）。 MDRAb감염환자상대우비 MDRAb환자호흡쇠갈발생솔고（74．5％ vs 40．0％，P ＜0．05）；인공기도사용솔고（72．5％ vs 40．0％，P ＜0．05）；감염상관적기관쇠갈（SOFA）평분고（9．73±2．88 vs 7．80±2．04，P＜0．05）；사망솔고（43．1％ vs 10．0％，P＜0．05）。결론 ICU감염적MDRAb대상용항생소내약엄중，하호흡도MDRAb감염다견우호흡쇠갈、건립인공기도、SOFA평분경고적환자；하호흡도MDRAb감염환자교비MDRAb감염환자병사솔고。
Objective To analyze the drug resistance of Acinetobacter baumannii in the patients with lower respiratory tract infection in respiratory intensive care unit and the relationship between clinical features and prognosis .Methods The patients with Acinetobacter baumannii infection in lower respiratory tract discharged from the respiratory intensive care unit (RICU ) of the Second Hospital of Hebei Medical University from August 2012 to February 2014 were enrolled into this study .The data including drug susceptibility results of Acinetobacter baumannii strains ,clinical features and outcome of all the patients were analyzed retrospectively to find out the possible relationship among them .Results Three hundred and fifty‐seven patients had admitted into the RICU of the Second Hospital of Hebei Medical University .Sixty‐one patients (61/357 ,17 .1% ) with Acinetobacter baumannii infections were enrolled into the study ,including 51 patients with MDRAb infection (51/61 ,83 .6% ) and 10 patients with non‐MDRAb infection (10/61 ,16 .4% ) .Two hundreds and sixty‐four Acinetobacter baumannii strains were collected totally .And 238 strains (238/264 ,90 .1% ) were identificated MDRAb ,the others 26 strains (26/264 ,9 .9% ) were non‐MDRAb .The resistance rate of the MDRAb to commonly used antibiotics for example Imipenem (97 .0% ) ,Meropenem (97 .0% ) ,Cefperazone‐Sulbactam (93 .9% ) , Levofloxacin (97 .3% ) ,Amikacin (68 .2% ) were higher in ICU .Cases analysis showed that the patients with respirtory failure ,aritificial airway and the higher SOFA scores had the higher MDRAb infections risks .And the patients with MDRAb infections had higher mortality .Conclusions The resistance rate of the MDRAb to commomly used antibiotics is the higher in ICU .Patients with respiratory failure ,aritificial airway and higher SOFA scores have higher lower respiratory tract MDRAb infections risks .And patients with MDRAb infections have higher mortality .