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比较肺炎与非肺炎相关鲍曼不动杆菌复合菌血症:一项单中心回顾性研究。

Comparison of pneumonia and nonpneumonia-related Acinetobacter baumannii complex bacteremia: A single-center retrospective study.

机构信息

Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 79 Qingchun Rd, Hangzhou, 310003, P. R. China.

Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 79 Qingchun Rd, Hangzhou, 310003, P. R. China.

出版信息

Am J Infect Control. 2023 May;51(5):567-573. doi: 10.1016/j.ajic.2022.08.004. Epub 2022 Aug 7.

Abstract

BACKGROUND

Acinetobacter baumannii complex (ABC) is a group of increasingly prevalent opportunistic pathogens that cause a variety of life-threatening nosocomial infections, especially in the intensive care unit (ICU). This study assessed the differences between pneumonia- and non-pneumonia-related ABC bacteremia and possible independent risk factors for 30-day mortality.

METHODS

The clinical data of ICU patients diagnosed with ABC bacteremia at a tertiary care hospital from January 2009 to December 2020 were collected, and sorted into groups of ABC bacteremia with and without pneumonia.

RESULTS

Significant changes in the incidence of ABC bacteremia and antibiotic resistance were observed over the 12-year study. Compared with nonpneumonia-related ABC bacteremia, pneumonia-related ABC bacteremia was associated with a higher rate of hypertension, less prior tigecycline use, more carbapenem-resistant (CR) strains, and a higher 30-day mortality rate. In multivariate analysis, immunosuppression, higher APACHE II score, and SOFA score were independent risk factors for 30-day mortality. Moreover, the risk of death was 1.919 times higher in the pneumonia-related group.

CONCLUSIONS

Although pneumonia-related ABC bacteremia had worse outcomes, it was not an independent risk factor for death statistically. Immunosuppression and disease severity levels increased the risks of death in ICU patients with ABC bacteremia.

摘要

背景

鲍曼不动杆菌复合体(ABC)是一组日益流行的机会致病菌,可引起多种危及生命的医院获得性感染,尤其是在重症监护病房(ICU)。本研究评估了肺炎相关和非肺炎相关 ABC 菌血症之间的差异以及 30 天死亡率的可能独立危险因素。

方法

收集了一家三级医院 2009 年 1 月至 2020 年 12 月 ICU 患者诊断为 ABC 菌血症的临床数据,并将其分为肺炎相关和非肺炎相关 ABC 菌血症组。

结果

在 12 年的研究中,ABC 菌血症的发病率和抗生素耐药性均发生了显著变化。与非肺炎相关的 ABC 菌血症相比,肺炎相关的 ABC 菌血症与高血压发生率较高、替加环素使用较少、耐碳青霉烯(CR)菌株较多以及 30 天死亡率较高有关。多变量分析表明,免疫抑制、较高的急性生理和慢性健康评估 II 评分(APACHE II)和序贯器官衰竭评估(SOFA)评分是 30 天死亡率的独立危险因素。此外,肺炎相关组的死亡风险增加了 1.919 倍。

结论

尽管肺炎相关的 ABC 菌血症预后较差,但从统计学上讲,它并不是死亡的独立危险因素。免疫抑制和疾病严重程度增加了 ICU 中患有 ABC 菌血症患者的死亡风险。

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