2022 年第 9 期 第 17 卷

多重耐药鲍曼不动杆菌血流感染及患者预后的危险因素分析

Risk factors for bloodstream infections due to multidrug-resistant Acinetobacter baumannii and patients′ prognosis

作者：圣朝军张明月张歆刚

英文作者：Sheng Zhaojun Zhang Mingyue Zhang Xingang

单位：中国人民解放军总医院第一医学中心呼吸与危重症医学科，北京100853

英文单位：Department of Pulmonary and Critical Care Medicine First Medical Center Chinese PLA General Hospital Beijing 100853 China

关键词：多重耐药鲍曼不动杆菌；血流感染；危险因素

英文关键词：Multidrug-resistantAcinetobacterbaumannii;Bloodstreaminfections;Riskfactors

• 摘要：

• 目的 探讨影响多重耐药鲍曼不动杆菌（MDR-Ab）血流感染及患者预后的危险因素。方法  回顾性分析2015年1月至2017年12月中国人民解放军总医院第一医学中心收治的115例血流感染患者的临床资料。115例患者血培养结果均为鲍曼不动杆菌（Ab）或MDR-Ab感染，并根据该结果分为Ab组（20例）和MDR-Ab组（95例）；根据MDR-Ab血流感染患者的病情转归，分为死亡组（42例）和存活组（53例）。收集患者年龄、性别、入住重症监护病房（ICU）、经验性抗菌药物使用等临床资料。分析患者感染MDR-Ab及其预后的危险因素。结果  MDR-Ab组病死率明显高于Ab组［44.2%（42/95）比15.0%（3/20）］（P＜0.05）。多因素非条件Logistic回归分析结果显示，侵入性操作、经验性使用碳青霉烯类药物、经验性治疗的抗菌药物种类≥3种是发生MDR-Ab血流感染的独立危险因素（均P＜0.05）。死亡组入住ICU、机械通气、合并免疫抑制状态、血流感染前器官衰竭比例均明显高于存活组（均P＜0.05）。经验性抗菌药物使用方面，死亡组使用碳青霉烯类药物、喹诺酮类药物、抗真菌药物、使用碳青霉烯类药物≥3 d、使用抗真菌药物≥3 d、使用抗菌药物种类≥3种比例均明显高于存活组（均P＜0.05）。多因素非条件Logistic回归分析，机械通气、血流感染前器官衰竭、免疫抑制状态以及经验性使用碳青霉烯类药物是MDR-Ab血流感染患者死亡的独立危险因素（均P＜0.05）。结论 侵入性操作、经验性使用碳青霉烯类药物、经验性治疗的抗菌药物种类≥3种是MDR-Ab血流感染的独立危险因素。机械通气、血流感染前器官衰竭、合并免疫抑制状态和经验性使用碳青霉烯类药物是MDR-Ab血流感染患者死亡的独立危险因素。

• Objective  To investigate the risk factors for bloodstream infections (BSI) due to multidrug-resistant Acinetobacter baumannii (MDR-Ab) and patients′ prognosis. Methods  Clinical data of 115 patients with BSI admitted to First Medical Center, Chinese PLA General Hospital from January 2015 to December 2017 were retrospectively analyzed. The blood culture results of the 115 patients were Acinetobacter baumannii (Ab) or MDR-Ab, and patients were divided into Ab group (20 cases) and MDR-Ab group (95 cases); according to the prognosis of patients with BSI due to MDR-Ab, they were divided into death group (42 cases) and survival group (53 cases). Clinical data such as age, gender, admission to intensive care unit (ICU), and empirical use of antibiotics were collected. The risk factors for MDR-Ab infection and patients′ prognosis were analyzed. Results  The mortality of MDR-Ab group was higher than that of Ab group ［44.2%（42/95） vs 15.0%（3/20）］(P<0.05). Multivariate unconditional Logistic regression analysis showed that invasive procedures, empirical use of carbapenems, and antibiotic types for empiric therapy≥3 were independent risk factors for BSI due to MDR-Ab (all P<0.05). Compared with survival group, the proportions of admission to ICU, mechanical ventilation, immunosuppressive status, and organ failure before BSI in death group were higher (all P<0.05); in terms of empirical use of antibiotics, proportions of carbapenems use, quinolones use, antifungal agents use, usage time of carbapenems≥3, usage time of antifungal agents≥3 d, and types of antibiotics≥3 in death group were higher (all P<0.05). Multivariate unconditional Logistic regression analysis showed that mechanical ventilation, organ failure before BSI, immunosuppressive status, and empirical use of carbapenems were independent risk factors for death in patients with BSI dut to MDR-Ab (all P<0.05). Conclusions  Invasive procedures, empirical use of carbapenems, and antibiotic types for empiric therapy≥3 are independent risk factors for BSI due to MDR-Ab. Mechanical ventilation, organ failure before BSI, immunosuppressive status, and empirical use of carbapenems are independent risk factors for death in patients with BSI dut to MDR-Ab.