【摘要】：目的探討浙江大學(xué)附屬第一醫(yī)院亞胺培南耐藥鮑曼不動(dòng)桿菌(IRAB)引起醫(yī)院獲得性肺炎(HAP)的危險(xiǎn)因素及預(yù)后,并了解該院IRAB的耐藥情況。方法回顧性分析該院2011年1月至2012年12月收治的201例鮑曼不動(dòng)桿菌醫(yī)院獲得性肺炎患者的臨床資料,其中IRAB組155例,亞胺培南敏感(ISAB)組46例,兩組間采取單因素分析及多因素Logistic回歸分析,分析IRAB HAP發(fā)生的危險(xiǎn)因素,并分析IRAB對(duì)其他16種抗菌藥物的耐藥情況,比較兩組患者30天病死率。結(jié)果單因素分析發(fā)現(xiàn):入住ICU、昏迷、氣管插管/切開(kāi)、機(jī)械通氣、留置胃管、糖皮質(zhì)激素使用≥1周、2種及以上抗生素聯(lián)用、分離出AB前28天內(nèi)碳青霉烯類抗生素使用、低白蛋白血癥、入院時(shí)APACHE II評(píng)分≥20分與IRAB HAP發(fā)生顯著相關(guān),多因素Logistic回歸分析發(fā)現(xiàn):分離出AB前28天內(nèi)碳青霉烯類抗生素使用、入院時(shí)APACHE II評(píng)分≥20分是IRAB HAP發(fā)生的獨(dú)立危險(xiǎn)因素;而IRAB僅對(duì)阿米卡星耐藥率較低(38.7%),對(duì)頭孢哌酮舒巴坦耐藥率高達(dá)64.5%,且對(duì)比ISAB,IRAB對(duì)大部分抗菌藥物耐藥率均明顯上升,IRAB組患者死亡率明顯上升。結(jié)論分離出AB前28天內(nèi)碳青霉烯類抗生素使用、入院時(shí)APACHE II評(píng)分≥20分是IRAB HAP發(fā)生的危險(xiǎn)因素,IRAB耐藥情況極其嚴(yán)重,均為多重耐藥菌株,IRAB HAP患者預(yù)后差,死亡率高。
[Abstract]:Objective to investigate the risk factors and prognosis of nosocomial pneumonia (HAP) caused by acinetobacter baumannii (IRAB) in the first affiliated Hospital of Zhejiang University, and to understand the drug resistance of IRAB in this hospital. Methods the clinical data of 201 patients with Acinetobacter baumannii nosocomial pneumonia from January 2011 to December 2012 were retrospectively analyzed, including 155 cases in IRAB group and 46 cases in imipenem sensitive (ISAB) group. Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of IRAB HAP and to analyze the drug resistance of IRAB to other 16 antimicrobial agents. The 30-day mortality of the two groups was compared. Results univariate analysis showed that ICU, coma, tracheal intubation / incision, mechanical ventilation, indwelling gastric tube, glucocorticoid use 鈮，

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