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重症监护病房中多重耐药鲍曼不动杆菌感染:一项回顾性分析

[Multidrug-resistant Acinetobacter Baumannii infection in Intensive Care Unit: A retrospective analysis].

作者信息

He Lujuan, Meng Jie, Huang Damao, Hu Chengping, Pan Pinhua

机构信息

Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.

Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015 Dec;40(12):1327-32. doi: 10.11817/j.issn.1672-7347.2015.12.007.

Abstract

OBJECTIVE

To analyze the clinical characteristics of patients with bloodstream Acinetobacter baumannii infection in Intensive Care Unit (ICU).

METHODS

Eighty-three ICU patients with bloodstream Acinetobacter baumannii infection from January 2012 to March 2015 were retrospectively analyzed, including infection-related risk factors, drug-resistant bacteria, treatments and prognosis.

RESULTS

Among 83 patients, 60 patients (72.29%) were male, 23 (27.71%) were female. The youngest patient was 40 days old, the oldest was 92 years old, the age was (46.23±19.22) years old. In total, there were 20 patients (24.10%) with plural bacterial infection in blood, 60 (72.29%) with more than 3 kinds of disorders, 52 patients suffered homologous bacterial infection in blood and other organs. Among these cases, lower respiratory tract had the highest percentage of homologous bacteria (29 cases), followed by catheter (11 cases), wound secretion (8 cases), cerebrospinal fluid (3 cases) and ascites (1 case). The risk factors of bloodstream infection by Acinetobacter baumannii included catheterization, serious primary disease and basic disease, usage of corticosteroids, surgery and invasive operation and so on. Acinetobacter baumannii were highly resistant. Most of them were multi-drug resistance, and some were pan-drug resistance. It showed more than 80% drug resistant rate to antibiotics except sulbactam, cefopcrazone and amikacin. Among 83 patients, 55 cases (66.26%) were dead, 25 cases (30.12%) were improved and 3 cases (3.62%) were cured.

CONCLUSION

Acinetobacter baumannii are highly and multidrug-resistant to commonly used antibiotics. Patients in ICU suffering serious basic diseases should be shorten hospitalization time, restricted the use of breathing machine and immunosuppressant. It must carry out disinfection for invasive operation to reduce the risk of bloodstream infections, and the abuse of antibiotics must be avoided to slow bacteria resistance.

摘要

目的

分析重症监护病房(ICU)血流鲍曼不动杆菌感染患者的临床特征。

方法

回顾性分析2012年1月至2015年3月在ICU发生血流鲍曼不动杆菌感染的83例患者,包括感染相关危险因素、耐药菌情况、治疗方法及预后。

结果

83例患者中,男性60例(72.29%),女性23例(27.71%)。年龄最小40天,最大92岁,平均年龄(46.23±19.22)岁。血行感染合并复数菌感染20例(24.10%),合并3种以上病症60例(72.29%),血行感染与其他器官同源菌感染52例。其中,同源菌比例最高的部位是下呼吸道(29例),其次为导管(11例)、伤口分泌物(8例)、脑脊液(3例)、腹水(1例)。鲍曼不动杆菌血流感染的危险因素包括导管置入、严重基础疾病及慢性病、使用糖皮质激素、手术及侵入性操作等。鲍曼不动杆菌耐药性高,多为多重耐药,部分为泛耐药,除对舒巴坦、头孢哌酮及阿米卡星外,对其他抗生素耐药率均超过80%。83例患者中,死亡55例(66.26%),好转25例(30.12%),治愈3例(3.62%)。

结论

鲍曼不动杆菌对常用抗生素高度耐药且多重耐药。ICU中患有严重基础疾病的患者应缩短住院时间,限制呼吸机及免疫抑制剂的使用。必须对侵入性操作进行消毒以降低血流感染风险,避免滥用抗生素以减缓细菌耐药性。

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