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目的探讨耐碳青霉烯类鲍氏不动杆菌(CRAB)医院获得性肺炎的危险因素。方法采用病例对照研究,收集2005年1月-2010年12月鲍氏不动杆菌(ABA)引起的医院获得性肺炎92例,分为CRAB医院获得性肺炎组30例和碳青霉烯类敏感鲍氏不动杆菌(CSAB)医院获得性肺炎组62例;采用单因素分析及多因素logistic回归分析。结果单因素分析发现,APACHEⅡ评分≥16分、气管插管或气管切开、机械通气、分离出ABA前<2周曾应用过亚胺培南或美罗培南、≥2种抗菌药物联合应用与CRAB感染有关;多因素logistic回归分析发现,APACHEⅡ≥16分(OR=4.144,95%Cl1.346～12.761,P=0.013)及分离出CRAB前<2周曾应用过亚胺培南或美罗培南(OR=3.236,95%Cl1.128～9.282,P=0.029)是独立危险因素;CRAB组死亡11例,CSAB组死亡19例,2组死亡率差异无统计学意义。结论 APACHEⅡ≥16分及分离出CRAB前<2周曾应用过亚胺培南或美罗培南,是CRAB医院获得性肺炎的独立危险因素。
Objective To investigate the risk factors of hospital-acquired pneumonia among carbapenem resistant Acinetobacter baumannii (CRAB). Methods A case-control study was conducted in which 92 cases of hospital acquired pneumonia caused by Acinetobacter baumannii (ABA) from January 2005 to December 2010 were collected and divided into CRAB hospital-acquired pneumonia group (30 cases) and carbapenem-sensitive 62 cases of Acinetobacter baumannii (CSAB) hospital-acquired pneumonia group; univariate analysis and multivariate logistic regression analysis. Results Univariate analysis showed that APACHE Ⅱ score ≥ 16 points, tracheal intubation or tracheotomy, mechanical ventilation, isolated ABA before <2 weeks have been used imipenem or meropenem, ≥ 2 kinds of antimicrobial agents combined with CRAB Multivariate logistic regression analysis showed that APACHEⅡ≥16 points (OR = 4.144,95% Cl1.346 ~ 12.761, P = 0.013) and imipenem or Meropenem OR = 3.236,95% Cl1.128 ~ 9.282, P = 0.029) were independent risk factors. There were 11 deaths in CRAB group and 19 deaths in CSAB group. There was no significant difference in mortality between two groups. Conclusions APACHEⅡ≥16 points and imipenem or meropenem have been used in <2 weeks before the isolation of CRAB, which is an independent risk factor for CRAB hospital acquired pneumonia.