Anunnatsiri Siriluck, Tonsawan Pantipa
Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Southeast Asian J Trop Med Public Health. 2011 May;42(3):693-703.
Multidrug-resistant (MDR) Acinetobacter baumannii has become a major cause of hospital-acquired infection worldwide. There are few papers regarding this particular subject. Our aim was to assess the incidence of bacteremia due to MDR Acinetobacter baumannii, factors associated with the infection, and clinical outcomes. We studied 49 cases of A. baumannii bacteremia in adult patients admitted to a university hospital in Northeast Thailand between 2005 and 2007. The incidence of MDR A. baumannii bacteremia was 3.6 episodes per 10,000 hospital admissions. Significantly independent factors associated with MDR A. baumannii bacteremia were previous: 1) ICU admission [odds ratio (OR) 10.01; 95% confidence interval (CI) 1.39-72.20]; 2) use of beta-lactam/beta-lactamase inhibitor antibiotics (OR 8.06; 95%CI 1.39-46.64); and 3) use of a carbapenem antibiotics (OR 11.40; 95%CI 1.44-89.98). The overall mortality rate was significantly higher in the MDR group than in the susceptible group (91.7% vs 48%, respectively) (p=0.001). The significantly independent factors related to mortality were: 1) APACHE II score (OR 1.25; 95%CI 1.03-1.52) and 2) secondary bacteremia (OR 14.86; 95%CI 1.37-161.90). This study revealed the significantly independent factors associated with MDR A. baumannii bacteremia were prior ICU admission and prior use of broad spectrum antibiotics. This infection has a high mortality rate. Emphasis needs to be on prevention, strict application of infection control and appropriate use of antibiotics.
多重耐药鲍曼不动杆菌已成为全球医院获得性感染的主要病因。关于这一特定主题的论文较少。我们的目的是评估多重耐药鲍曼不动杆菌所致菌血症的发生率、与感染相关的因素以及临床结局。我们研究了2005年至2007年期间入住泰国东北部一所大学医院的成年患者中49例鲍曼不动杆菌菌血症病例。多重耐药鲍曼不动杆菌菌血症的发生率为每10000例住院患者中有3.6例。与多重耐药鲍曼不动杆菌菌血症显著相关的独立因素包括既往：1）入住重症监护病房[比值比（OR）10.01；95%置信区间（CI）1.39 - 72.20]；2）使用β-内酰胺/β-内酰胺酶抑制剂抗生素（OR 8.06；95%CI 1.39 - 46.64）；以及3）使用碳青霉烯类抗生素（OR 11.40；95%CI 1.44 - 89.98）。多重耐药组的总体死亡率显著高于敏感组（分别为91.7%和48%）（p = 0.001）。与死亡率显著相关的独立因素为：1）急性生理与慢性健康状况评分系统II（APACHE II）评分（OR 1.25；95%CI 1.03 - 1.52）和2）继发性菌血症（OR 14.86；95%CI 1.37 - 161.90）。本研究表明，与多重耐药鲍曼不动杆菌菌血症显著相关的独立因素是既往入住重症监护病房和既往使用广谱抗生素。这种感染死亡率很高。需要强调预防、严格实施感染控制以及合理使用抗生素。
