泛耐药鲍氏不动杆菌医院感染危险因素分析
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摘要
目的探究泛耐药鲍氏不动杆菌医院感染危险因素,为医院感染预防控制提供理论依据。方法回顾性分析医院2017年泛耐药鲍氏不动杆菌(PDR-AB)医院感染病例信息,并与同期普通多药耐药鲍氏不动杆菌医院感染病例进行对比,单因素分析及多因素非条件Logistic回归分析泛耐药鲍氏不动杆菌医院感染危险因素。结果单因素分析结果表明,病例组手术比例、使用中心静脉置管比例、入住ICU比例、使用抗菌药物种类3种及以上比例、多种抗菌药物联用天数及感染前亚胺培南、哌拉西林/他唑巴坦应用比例均高于对照组,差异有统计学意义(P<0.05);多因素非条件Logistic回归分析结果表明,入住ICU为泛耐药鲍氏不动杆菌医院感染独立危险因素。医院感染患者科室分布中,以重症医学科为主占71.43%(10/14),病原菌检出标本以痰液标本为主占57.14%(8/14)。结论接受手术治疗、使用中心静脉置管、入住ICU、抗菌药物使用种类较多、3种及以上抗菌药物联用时间较长、使用亚胺培南、哌拉西林/他唑巴坦为PDR-AB感染危险因素,其中入住ICU可能为PDR-AB感染独立危险因素。患者主要来自重症医学科,病原菌检出标本以痰液为主。
OBJECTIVE To explore the risk factors for pandrug-resistant Acinetobacter baumannii(PDR-AB)nosocomial infection so as to provide theoretical basis for prevention and control of nosocomial infection.METHODS The clinical data of patients with PDR-AB nosocomial infection who were treated in the hospital in 2017 were retrospectively analyzed and were compared with the clinical data of patients with common multidrug-resistant Acinetobacter baumannii(MDR-AB)nosocomial infection.The univariate analysis and non-conditional multivariate logistic regression analysis were performed for the risk factors for the PDR-AB nosocomial infection.RESULTS The result of univariate analysis indicated that the proportions of the patients who were given surgical procedures,treated with central venous catheter,hospitalized in ICU and treated with no less than 3 types of antibiotics,the duration of use of multiple antibiotics and treated with imipenem and piperacillin-tazobactam before infection were higher in the case group than in the control group,and there were significant differences(P<0.05).The result of the non-conditional multivariate logistic regression analysis indicated that the ICU stay was the independent risk factor for the PDR-AB nosocomial infection.Among the patients with nosocomial infection,71.43%(10/14)came from critical care medicine department.Sputum specimens were dominant among the specimens where the pathogens were isolated,accounting for 57.14%(8/14).CONCLUSION The risk factors for the PDR-AB infection include surgical treatment,central venous catheterization,ICU stay,use of multiple antibiotics,long-term use of no less than 3 types of antibiotics and use of imipenem and piperacillin-tazobactam,and the ICU stay is the independent risk factor for the PDR-AB infection.Most of the patients come from the critical care medicine department,and the sputum specimens are dominant among the specimens where the pathogens are isolated.
OBJECTIVE To explore the risk factors for pandrug-resistant Acinetobacter baumannii(PDR-AB)nosocomial infection so as to provide theoretical basis for prevention and control of nosocomial infection.METHODS The clinical data of patients with PDR-AB nosocomial infection who were treated in the hospital in 2017 were retrospectively analyzed and were compared with the clinical data of patients with common multidrug-resistant Acinetobacter baumannii(MDR-AB)nosocomial infection.The univariate analysis and non-conditional multivariate logistic regression analysis were performed for the risk factors for the PDR-AB nosocomial infection.RESULTS The result of univariate analysis indicated that the proportions of the patients who were given surgical procedures,treated with central venous catheter,hospitalized in ICU and treated with no less than 3 types of antibiotics,the duration of use of multiple antibiotics and treated with imipenem and piperacillin-tazobactam before infection were higher in the case group than in the control group,and there were significant differences(P<0.05).The result of the non-conditional multivariate logistic regression analysis indicated that the ICU stay was the independent risk factor for the PDR-AB nosocomial infection.Among the patients with nosocomial infection,71.43%(10/14)came from critical care medicine department.Sputum specimens were dominant among the specimens where the pathogens were isolated,accounting for 57.14%(8/14).CONCLUSION The risk factors for the PDR-AB infection include surgical treatment,central venous catheterization,ICU stay,use of multiple antibiotics,long-term use of no less than 3 types of antibiotics and use of imipenem and piperacillin-tazobactam,and the ICU stay is the independent risk factor for the PDR-AB infection.Most of the patients come from the critical care medicine department,and the sputum specimens are dominant among the specimens where the pathogens are isolated.
引文
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[10]张鹏,周燕斌,黄炎明,等.多重耐药鲍曼不动杆菌医院获得性肺炎的危险因素及预后分析[J].中国感染与化疗杂志,2015,15(6):527-532.
[11]Liu Q,Li W,Du X,et al.Risk and prognostic factors for multidrug-resistant Acinetobacter baumannii complex bacteremia:a retrospective study in a tertiary hospital of West China[J].PLOS One,2015,10(6):e130701.
[12]Fukuta Y,Muder RR,Agha ME,et al.Risk factors for acquisition of multidrug-resistant Acinetobacter baumannii among cancer patients[J].Am J Infect Control,2013,41(12):1249-1252.
[13]Guo N,Xue W,Tang D,et al.Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China[J].Am J Infect Control,2016,44(4):e37-e39.
[14]中华人民共和国国家卫生健康委员会.医院感染管理质量控制指标(2015年版)(国卫办医函[2015]252号)[EB/OL].[2015-04-10].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/04/20150410161734535.doc.
[15]中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,81(5):314-320.
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[17]李亚婷,阎田园,王书会,等.脑卒中手术患者医院感染发生率及经济负担分析[J].中国感染控制杂志,2018,28(18):2796-2798.
[18]纪灏,张静,窦颖,等.应用DALY结合人力资本法研究某三甲专科医院医院获得性重症肺炎的间接经济负担[J].中国感染控制杂志,2018,17(12):1055-1059.
[19]罗赛赛,郑巧伟,董亚琳,等.我院2013-2016年耐碳青霉烯类铜绿假单胞菌医院感染的危险因素与临床结局分析[J].临床药学,2018,29(5):667-670.
[20]Chopra T,Marchaim D,Awali RA,et al.Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes[J].Antimicrob Agents Chemother,2013,57(12):6270-6275.
[21]Ballouz T,Aridi J,Afif C,et al.Risk factors,clinical presentation,and outcome of Acinetobacter baumannii bacteremia[J].Front Cell Infect Mi,2017,7(156):1-8.
[22]张辉,张小江,徐英春,等.2012年中国CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):392-397.
[23]付沛文,范文廷,姜飞,等.2013-2015年鲍曼不动杆菌感染分布特征与耐药性变迁[J].临床与病理杂志,2016,36(11):1827-1832.
[24]Thom KA,Maragakis LL,Richards K,et al.Assessing the burden of Acinetobacter baumannii in Maryland:a statewide cross-sectional period prevalence survey[J].Infect Control Hosp Epidemiol,2012,33(9):883-888.
[25]徐雄,徐斌,王玉月,等.呼吸科泛耐药鲍曼不动杆菌感染的危险因素分析[J].热带医学杂志,2014,14(12):1613-1616.
[26]王悦,郭晓奎.抗生素对人体微生物菌群的影响及新型抗感染方式展望[J].中国抗生素杂志,2018,43(8):966-970.
[27]肖淑珍,徐桂婷,方洁,等.鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性分析[J].中国感染与化疗杂志,2013,13(6):446-449.
[28]董宏亮,马岩敏,申遇春,等.我院抗菌药物使用与鲍曼不动杆菌耐药的相关性分析[J].西北药学杂志,2018,33(2):263-266.
[29]Uwingabiye J,Lemnouer A,Baidoo S,et al.Intensive care unit-acquired Acinetobacter baumannii infections in a Moroccan teaching hospital:epidemiology,risk factors and outcome[J].Germs,2017,7(4):193-205.
[2]张焱,黄新玲,孙洁,等.重症医学科连续5年鲍曼不动杆菌感染分布及耐药性变迁[J].中国感染控制杂志,2017,16(1):54-57.
[3]蔺飞,贾旭,凌保东.鲍曼不动杆菌对消毒剂耐药机制的研究[J].中国抗菌药物杂志,2017,42(2):81-89.
[4]Teerawattanapong N,Panich P,Kulpokin D,et al.A systematic review of the burden of multidrug-resistant healthcareassociated infections among intensive care unit patients in Southeast Asia:the rise of multidrug-resistant Acinetobacter baumannii[J].Infect Control Hosp Epidemiol,2018,39(5):515-533.
[5]郭轶斌,郭威,邱佩琪,等.多药耐药与非耐药鲍曼不动杆菌院内感染的归因住院费用与住院时长研究[J].中国卫生统计,2017,34(3):378-381.
[6]Kim SY,Jung JY,Kang YA,et al.Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit[J].J Korean Med Sci,2012,27(8):939-947.
[7]Liu CP,Shih SC,Wang NY,et al.Risk factors of mortality inpatients with carbapenem-resistant Acinetobacter baumannii bacteremia[J].J Microbiol Immunol Infect,2016,49(6):934-940.
[8]Lee HY,Chen CL,Wu SR,et al.Risk factors and outcome analysis of Acinetobacter baumannii complex bacteremia in critical patients[J].Crit Care Med,2014,42(5):1081-1088.
[9]李娜,黄艳芳,唐喻莹,等.多重耐药鲍曼不动杆菌医院感染危险因素荟萃分析[J].中国感染控制杂志,2017,16(2):115-120.
[10]张鹏,周燕斌,黄炎明,等.多重耐药鲍曼不动杆菌医院获得性肺炎的危险因素及预后分析[J].中国感染与化疗杂志,2015,15(6):527-532.
[11]Liu Q,Li W,Du X,et al.Risk and prognostic factors for multidrug-resistant Acinetobacter baumannii complex bacteremia:a retrospective study in a tertiary hospital of West China[J].PLOS One,2015,10(6):e130701.
[12]Fukuta Y,Muder RR,Agha ME,et al.Risk factors for acquisition of multidrug-resistant Acinetobacter baumannii among cancer patients[J].Am J Infect Control,2013,41(12):1249-1252.
[13]Guo N,Xue W,Tang D,et al.Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China[J].Am J Infect Control,2016,44(4):e37-e39.
[14]中华人民共和国国家卫生健康委员会.医院感染管理质量控制指标(2015年版)(国卫办医函[2015]252号)[EB/OL].[2015-04-10].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/04/20150410161734535.doc.
[15]中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,81(5):314-320.
[16]Clinical and Laboratory Standards Institute.Performance Standards for Antimicrobial Susceptibility Testing:27th informational supplement,M100-S27[S]:CLSI,2017.
[17]李亚婷,阎田园,王书会,等.脑卒中手术患者医院感染发生率及经济负担分析[J].中国感染控制杂志,2018,28(18):2796-2798.
[18]纪灏,张静,窦颖,等.应用DALY结合人力资本法研究某三甲专科医院医院获得性重症肺炎的间接经济负担[J].中国感染控制杂志,2018,17(12):1055-1059.
[19]罗赛赛,郑巧伟,董亚琳,等.我院2013-2016年耐碳青霉烯类铜绿假单胞菌医院感染的危险因素与临床结局分析[J].临床药学,2018,29(5):667-670.
[20]Chopra T,Marchaim D,Awali RA,et al.Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes[J].Antimicrob Agents Chemother,2013,57(12):6270-6275.
[21]Ballouz T,Aridi J,Afif C,et al.Risk factors,clinical presentation,and outcome of Acinetobacter baumannii bacteremia[J].Front Cell Infect Mi,2017,7(156):1-8.
[22]张辉,张小江,徐英春,等.2012年中国CHINET不动杆菌属细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):392-397.
[23]付沛文,范文廷,姜飞,等.2013-2015年鲍曼不动杆菌感染分布特征与耐药性变迁[J].临床与病理杂志,2016,36(11):1827-1832.
[24]Thom KA,Maragakis LL,Richards K,et al.Assessing the burden of Acinetobacter baumannii in Maryland:a statewide cross-sectional period prevalence survey[J].Infect Control Hosp Epidemiol,2012,33(9):883-888.
[25]徐雄,徐斌,王玉月,等.呼吸科泛耐药鲍曼不动杆菌感染的危险因素分析[J].热带医学杂志,2014,14(12):1613-1616.
[26]王悦,郭晓奎.抗生素对人体微生物菌群的影响及新型抗感染方式展望[J].中国抗生素杂志,2018,43(8):966-970.
[27]肖淑珍,徐桂婷,方洁,等.鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性分析[J].中国感染与化疗杂志,2013,13(6):446-449.
[28]董宏亮,马岩敏,申遇春,等.我院抗菌药物使用与鲍曼不动杆菌耐药的相关性分析[J].西北药学杂志,2018,33(2):263-266.
[29]Uwingabiye J,Lemnouer A,Baidoo S,et al.Intensive care unit-acquired Acinetobacter baumannii infections in a Moroccan teaching hospital:epidemiology,risk factors and outcome[J].Germs,2017,7(4):193-205.