Katsaragakis Stilianos, Markogiannakis Haridimos, Toutouzas Konstantinos G, Drimousis Panagiotis, Larentzakis Andreas, Theodoraki Eleni-Maria, Theodorou Dimitrios
Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens 11527, Greece.
World J Surg. 2008 Jun;32(6):1194-202. doi: 10.1007/s00268-008-9571-3.
This study was designed to evaluate Acinetobacter baumannii infections incidence in our Surgical Intensive Care Unit, clinical features and outcome of these patients, and multi-resistance incidence to identify predictors of such a resistance.
Prospective study of all patients with ICU-acquired Acinetobacter baumannii infection from June 1, 2003 to May 31, 2005. Patients with multi-resistant infection, susceptible exclusively to colistin, were compared with those sustaining non-multi-drug resistant infection.
Among 411 patients, 52 (12.6%) developed Acinetobacter infection. Their mean age was 66.3 +/- 8.4 years and APACHE II 20.4 +/- 7.3 (men: 51.9%). Infection sites were: bloodstream (46.2%), respiratory tract (32.7%), central venous catheter (11.5%), surgical site (7.7%), and urinary tract (1.9%). High multi-resistance (44.2%), morbidity (63.4%), and mortality (44.2%) were identified. Colistin was the most effective antibiotic (100% susceptibility), whereas resistance against all other antibiotics was >60%. Previous septic shock (p = 0.04), previous adult respiratory distress syndrome (ARDS) (p = 0.01), number of previous antibiotics (p = 0.01), previous aminoglycoside use (p = 0.04), and reoperation (p = 0.01) were risk factors for multi-resistance in univariate analysis. Morbidity in the multi-resistant group was significantly higher than the non-multi-resistant group (82.6% vs. 48.2%, p = 0.02). Mortality in the multi-resistant group also was higher; however, this difference did not marginally reach statistical significance (60.8% vs. 31.1%, p = 0.06). Multivariate analysis identified previous septic shock (p = 0.04; odds ratio (OR), 9.83; 95% confidence interval (CI), 1.003-96.29) and reoperation (p = 0.01; OR, 8.45; 95% CI, 1.52-46.85) as independent predictors of multi-resistance.
Acinetobacter baumannii infections are frequent and associated with high morbidity, mortality, and multi-resistance. Avoidance of unnecessary antibiotics is a high priority, and specific attention should be paid to patients with previous ARDS and, particularly, previous septic shock and reoperation. When such risk factors are identified, colistin may be the only appropriate treatment.
本研究旨在评估我院外科重症监护病房鲍曼不动杆菌感染的发生率、这些患者的临床特征及转归，以及多重耐药的发生率，以确定此类耐药的预测因素。
对2003年6月1日至2005年5月31日期间所有发生重症监护病房获得性鲍曼不动杆菌感染的患者进行前瞻性研究。将多重耐药感染且仅对黏菌素敏感的患者与未发生多重耐药感染的患者进行比较。
411例患者中，52例（12.6%）发生了鲍曼不动杆菌感染。他们的平均年龄为66.3±8.4岁，急性生理与慢性健康状况评分系统II（APACHE II）评分为20.4±7.3（男性占51.9%）。感染部位包括：血流（46.2%）、呼吸道（32.7%）、中心静脉导管（11.5%）、手术部位（7.7%）和泌尿道（1.9%）。发现存在高多重耐药率（44.2%）、发病率（63.4%）和死亡率（44.2%）。黏菌素是最有效的抗生素（敏感性达100%），而对所有其他抗生素的耐药率均>60%。在单因素分析中，既往发生过脓毒性休克（p = 0.04）、既往发生过成人呼吸窘迫综合征（ARDS）（p = 0.01）、既往使用抗生素的数量（p = 0.01）、既往使用过氨基糖苷类药物（p = 0.04）和再次手术（p = 0.01）是多重耐药的危险因素。多重耐药组的发病率显著高于非多重耐药组（82.6%对48.2%，p = 0.02）。多重耐药组的死亡率也更高；然而，这种差异未达到统计学意义（60.8%对31.1%，p = 0.06）。多因素分析确定既往脓毒性休克（p = 0.04；比值比（OR），9.83；95%置信区间（CI），1.003 - 96.29）和再次手术（p = 0.01；OR，8.45；95% CI，1.52 - 46.85）是多重耐药的独立预测因素。
鲍曼不动杆菌感染很常见，且与高发病率、死亡率及多重耐药相关。避免不必要的抗生素使用是当务之急，应特别关注既往发生过ARDS的患者，尤其是既往发生过脓毒性休克和再次手术的患者。当识别出此类危险因素时，黏菌素可能是唯一合适的治疗药物。
