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目的探讨综合重症监护病房(CICU)内鲍曼不动杆菌耐药性及其影响因素。方法选取2016年4月—2017年4月巴中市中心医院CICU收治的鲍曼不动杆菌感染患者40例作为感染组,另选取2016年4月—2017年4月巴中市中心医院CICU收治的未感染鲍曼不动杆菌患者40例作为未感染组。观察感染组患者鲍曼不动杆菌标本分布情况及耐药情况,鲍曼不动杆菌感染的影响因素分析采用多因素Logistic回归分析。结果鲍曼不动杆菌主要由痰液中分离出来,共30株,占75.0%。鲍曼不动杆菌对哌拉西林、头孢噻肟的耐药率达85.0%;鲍曼不动杆菌对头孢曲松、阿米卡星、复方新诺明的耐药率达82.5%;鲍曼不动杆菌对亚胺培南的耐药率较低,达52.5%。两组患者性别、年龄、接受静脉置管者所占比例、肺神经系统疾病阳性率、应用激素治疗者所占比例比较,差异无统计学意义(P>0.05);感染组患者GCS评分<8分者所占比例、清蛋白水平<25g/L者所占比例、肺通气时间>1周者所占比例、接受气管插管者所占比例、接受气管切开者所占比例、混合细菌感染阳性率、肺基础疾病阳性率、抗菌药物种类>2种者所占比例、入住CICU时间>1周者所占比例高于未感染组(P<0.05)。多因素Logistic回归分析结果显示,GCS评分<8分[OR=2.964,95%CI(1.424,6.973)]、清蛋白水平<25g/L[OR=3.023,95%CI(1.384,6.681)]、机械通气时间>1周[OR=3.045,95%CI(1.091,6.474)]、气管插管[OR=3.217,95%CI(1.240,8.343)]、气管切开[OR=3.013,95%CI(1.145,7.025)]、混合细菌感染[OR=3.620,95%CI(1.305,8.113)]、抗菌药物种类>2种[OR=3.215,95%CI(1.071,6.670)]是鲍曼不动杆菌感染患者的影响因素(P<0.05)。结论 CICU患者鲍曼不动杆菌耐药率较高,GCS评分<8分、清蛋白水平<25g/L、机械通气时间>1周、气管插管、气管切开、混合细菌感染、抗菌药物种类>2种是鲍曼不动杆菌感染患者的影响因素。
Objective To investigate the drug resistance and influencing factors of Acinetobacter baumannii in the intensive care unit (CICU). Methods From April 2016 to April 2017, 40 patients with Acinetobacter baumannii infection in CICU of Central Hospital of Bazhong were selected as the infection group. Patients with CICU were selected from April 2016 to April 2017 in Central Hospital of Bazhong Of uninfected Acinetobacter baumannii 40 cases as uninfected group. Observed the infection group Acinetobacter baumannii specimens distribution and drug resistance, Acinetobacter baumannii infection factor analysis using multivariate Logistic regression analysis. Results Acinetobacter baumannii was mainly isolated from sputum, a total of 30 strains, accounting for 75.0%. Acinetobacter baumannii to piperacillin and cefotaxime resistance rate was 85.0%; Acinetobacter baumannii ceftriaxone, amikacin, cotrimoxazole resistance rate of 82.5%; Bauman Acinetobacter resistant to imipenem was lower, reaching 52.5%. There was no significant difference in sex, age, proportion of patients receiving intravenous catheterization, positive rate of pulmonary nervous system diseases, and proportion of hormone therapy in the two groups (P> 0.05). The GCS score of patients with infection was <8 Proportion of patients, the proportion of albumin <25g / L, lung ventilation time> 1 week, the proportion of tracheal intubation, tracheostomy, the proportion of mixed bacterial infection Positive rate of lung disease, the positive rate of lung diseases, antimicrobial drugs> the proportion of two kinds of persons, occupancy CICU time> 1 week, the proportion was higher than the non-infected group (P <0.05). Multivariate Logistic regression analysis showed that GCS score <8 points [OR = 2.964,95% CI (1.424,6.973)], albumin level <25 g / L [OR = 3.023,95% CI 1.384,6.681] (OR = 3.045, 95% CI 1.091, 6.474), endotracheal intubation (OR = 3.217, 95% CI 1.240, 8.343), tracheostomy OR 3.013, 95% CI (1.145, 7.025)], mixed bacterial infection [OR = 3.620,95% CI (1.305,8.113)], antibacterials> 2 [OR = 3.215,95% CI (1.071,6.670) Influenza infection in patients with factors (P <0.05). Conclusions Acinetobacter baumannii is more resistant in CICU patients with GCS score <8, albumin level <25g / L, mechanical ventilation time> 1 week, tracheal intubation, tracheotomy, mixed bacterial infection, antimicrobial drug > 2 are the influencing factors of Acinetobacter baumannii infection.