[1]符佩姝,孙凤军,冯伟,等.神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析[J].第三军医大学学报,2019,41(07):706-711.
 FU Peishu,SUN Fengjun,FENG Wei,et al.Drug resistance of Acinetobacter baumannii and risk factors of its infection in neurosurgery [J].J Third Mil Med Univ,2019,41(07):706-711.
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神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第07期
页码:
706-711
栏目:
临床医学
出版日期:
2019-04-15

文章信息/Info

Title:
Drug resistance of Acinetobacter baumannii and risk factors of its infection in neurosurgery
 
作者:
符佩姝孙凤军冯伟李晓宇夏培元
陆军军医大学(第三军医大学)第一附属医院药学部; 解放军第980医院邯郸分院药剂科
Author(s):
FU Peishu SUN Fengjun FENG Wei LI Xiaoyu XIA Peiyuan  

Department of Pharmacy, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038; Department of Pharmacy, Handan Branch of No. 980 Hospital of PLA, Handan, Hebei Province, 056000, China

关键词:
鲍曼不动杆菌耐药率细菌感染危险因素神经外科
Keywords:
Acinetobacter baumanniidrug resistance bacterial infections risk factor neurosurgery departmen
分类号:
R378.7; R651; R915
文献标志码:
A
摘要:

目的 分析神经外科鲍曼不动杆菌的耐药性及感染鲍曼不动杆菌的危险因素。方法 选取2017年陆军军医大学第一附属医院神经外科感染鲍曼不动杆菌的病例62例,用琼脂倍比稀释法测定临床常用抗菌药物对鲍曼不动杆菌的最小抑菌浓度;采用病例对照的研究方法,选择同期细菌培养为非鲍曼不动杆菌感染的病例174例为对照组,收集临床数据,应用单因素分析及多因素Logistic回归分析感染鲍曼不动杆菌的危险因素。结果 鲍曼不动杆菌对临床常用的抗菌药物除左氧氟沙星外耐药率均大于50%。单因素分析发现神经外科感染鲍曼不动杆菌的危险因素包括:年龄,感染前住院时间≥14 d,感染前入住ICU时间≥7 d,格拉斯哥昏迷评分(GSC评分)≤8分,急性生理与慢性健康评分(APACHEⅡ评分)≥20分,感染前4代头孢、β内酰胺类加酶抑制剂、碳青霉烯类、替加环素的使用,机械通气及留置胃管。多因素回归分析结果显示:感染前入住ICU时间≥7 d(OR=4.179,95%CI:1.638~10.662)、APACHEⅡ评分≥20分(OR=5.798,95%CI:1.695~19.829)、机械通气(OR=3.726,95%CI:1.571~8.840)及感染前β-内酰胺类加酶抑制剂的使用(OR=3.709,95%CI:1.353~10.168)为神经外科患者鲍曼不动杆菌感染的独立危险因素。结论 鲍曼不动杆菌对临床常用的抗菌药物耐药率高,感染前入住ICU时间≥7 d、APACHEⅡ评分≥20分、机械通气及感染前使用β-内酰胺类加酶抑制剂为神经外科患者鲍曼不动杆菌感染的独立危险因素。
 

Abstract:

Objective To investigate the drug resistance and the risk factors infected by Acinetobacter baumannii (A. baumannii) in neurosurgery. Methods A total of 62 cases with A. baumannii infection admitted in the neurosurgery of our hospital during January and December 2017 were enrolled in this study. The minimum inhibitory concentrations of common antibacterial drugs against A. baumannii were determined by agar dilution. The case-control study method was used to select the 174 non-A. baumannii infection cases as the control group, and their clinical data were collected. The risk factors of A. baumannii infection were analyzed by univariate analysis and multivariate logistic regression. Results A. baumannii strains were much higher resistant to clinically used antibacterial drugs, except levofloxacin, with the resistant rates were more than 50%. Univariate analysis found that age, pre-infection length of hospital stay ≥14 d, ICU length before infection ≥7 d, GSC score≤8, APACHEⅡ  score≥20, usages of 4th generation of cephalosporins, β-lactam enzyme inhibitor, carbapenems and tigecycline before infection, and mechanical ventilation and indwelling gastric tube were risk factors for A. baumannii infection in neurosurgery (P<0.05). Multivariate regression analysis showed that the length of ICU stay before infection ≥7 d (OR=4.179, 95%CI: 1.638~10.662), APACHEⅡ score≥20 (OR=5.798, 95%CI: 1.695~19.829), mechanical ventilation (OR=3.726, 95%CI: 1.571~8.840) and the usage of β-lactam enzyme inhibitors before infection (OR=3.709, 95%CI: 1.353~10.168) were independent risk factors for the patients with A. baumannii infection in neurosurgery. Conclusion The resistance rate of A. baumannii in neurosurgery is quite high. The length of ICU stay before infection ≥7 d, APACHEⅡ score ≥20, mechanical ventilation and usage of β-lactam enzyme inhibitors before infection are independent risk factors for A. baumannii infection in neurosurgery.

参考文献/References:

[1]RODRGUEZBAO J, CISNEROS J M, FERNNDEZCUENCA F, et al. Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals[J]. Infect Control Hosp Epidemiol, 2004, 25(10): 819-824. DOI:10.1086/502302.
[2]QURESHI Z A, HITTLE L E, O’HARA J A, et al. Colistinresistant Acinetobacter baumannii: beyond carbapenem resistance[J]. Clin Infect Dis, 2015, 60(9): 1295-1303. DOI:10.1093/cid/civ048.
[3]AGODI A, VOULGARI E, BARCHITTA M, et al. Spread of a carbapenem and colistinresistant Acinetobacter baumannii ST2 clonal strain causing outbreaks in two Sicilian hospitals[J]. J Hosp Infect, 2014, 86(4): 260-266. DOI:10.1016/j.jhin.2014.02.001.
[4]PEREZ F, HUJER A M, HUJER K M, et al. Global challenge of multidrugresistant Acinetobacter baumannii[J]. Antimicrob Agents Chemother, 2007, 51(10): 3471-3484. DOI:10.1128/AAC.01464-06.
[5]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. DOI:10.3969/j.issn.1009-7708.2015.06.005.
ZHANG P, ZHOU Y B, HUANG Y M, et al. Risk factors and prognosis of hospitalacquired pneumonia due to multidrug-resistant Acinetobacter baumannii[J]. Chin J Infect Chemother, 2015, 15(6): 527-532. DOI:10.3969/j.issn.1009-7708.2015.06.005.
[6]中华医学会神经外科学分会,中国神经外科重症管理协作组.中国神经外科重症患者感染诊治专家共识(2017)[J]. 中华医学杂志,2017,97(21):1607-1614. DOI:10.3760/cma.j.issn.03762491.2017.21.005.
Chinese Medical Association Branch of Neurosurgery, Chinese Neurosurgery Critical Management Collaborative Group. Expert consensus on diagnosis and treatment of severely infected patients in neurosurgery in China (2017) [J]. Natl Med J China, 2017, 97(21): 1607-1614. DOI:10.3760/cma.j.issn.0376-2491.2017.21.005.
[7]HORAN T C,ANDRUS M,DUDECK M A. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting [J]. Am J Infect Control,2008, 36(5): 309-332.DOI:10.1016/j.ajic.2008.03.002.
[8]张勇, 周华, 杨青, 等. 鲍曼不动杆菌临床分布、耐药性分析和肺部感染病例的预后研究[J]. 中国微生态学杂志, 2014,26(5): 530-533. DOI:10.13381/j.cnki.cjm.201405009.
ZHANG Y,ZHOU H,YANG Q,et al. Analysis on clicinal distribution and resistance of Acinetobacter baumannii and prognosis of pneumonia cases[J]. Chin J Microecol,2014, 26(5): 530-533. DOI:10.13381/j.cnki.cjm.201405009.
[9]涂盛,邵安文,朱曼华,等. 鲍曼不动杆菌的临床分布、耐药情况及其感染危险因素分析[J]. 中国微生态学杂志,2016,28(12):1416-1419,1428. DOI:10.13381/j.cnki.cjm.201612014.
TU S,SHAO A W,ZHU M H,et al.Clinical distribution and drug resistance of Acinetobacter baumannii and the risk factors of the infections[J].Chin J Microecol,2016,28(12):1416-1419,1428. DOI:10.13381/j.cnki.cjm.201612014.
[10]胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志, 2018, 18(3): 241-251. DOI: 10.16718/j.1009-7708.2018.03.001.
HU F P, GUO Y,ZHU D M,et al. Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET Surveillance Program, 2017 [J]. Chin J Infect Chemother,2018,18(3): 241-251. DOI:10.16718/j.1009-7708.2018.03.001.
[11]周珊, 徐修礼, 樊新, 等. 神经外科鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌的分布及耐药性分析[J]. 临床合理用药杂志, 2013, 6(10): 9-11. DOI:10.3969/j.issn.16743296.2013.10.008.
ZHOU S, XU X L, FAN X, et al. Distribution and drug resistance analysis of baumanii, pseudomonas aeruginosa, staphylococcus aureus in neurosurgery[J]. Chin J Clin Rational Drug Use, 2013, 6(10): 9-11. DOI:10.3969/j.issn.16743296.2013.10.008.
[12]LI Y J,PAN C Z,FANG C Q, et al. Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients: genetic relationships,risk factors and mortality [J]. BMC Infect Dis,2017, 17(1): 371.DOI: 10.1186/s12879-017-2471-0.
[13]李双, 张广庆, 刘玉才. 替加环素不同治疗方案对ICU泛耐药鲍曼不动杆菌肺部感染的临床效果对比观察[J]. 中国抗生素杂志, 2018,43(2):139-145. DOI:10.13461/j.cnki.cja.006170.
LI S, ZHANG G Q,LIU Y C. Comparison of different therapeutic regimens of tigecycline in the treatment of ICU patients with pneumonia caused by extensively drug resistant Acinetobacter baumannii[J]. Chin J Antibiot,2018,43(2):139-145. DOI:10.13461/j.cnki.cja.006170.
[14]JU M H, HOU D N, CHEN S, et al. Risk factors for mortality in ICU patients with Acinetobacter Baumannii ventilator-associated pneumonia: impact of bacterial cytotoxicity[J]. J Thorac Dis, 2018, 10(5): 2608-2617. DOI:10.21037/jtd.2018.04.86.
[15]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. DOI:10.18683/germs.2017.1126.
[16]HUANG H P, CHEN B R, LIU G, et al. A multicenter study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii[J]. BMC Infect Dis, 2018, 18(1): 11. DOI:10.1186/s12879-017-2932-5.
[17]SULTAN A M,SELIEM W A. Identifying risk factors for healthcareassociated infections caused by carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit [J]. Sultan Qaboos Univ Med J,2018, 18(1): e75-e80.DOI: 10.18295/squmj.2018.18.01.012.
[18]ROCA I,ESPINAL P,VILAFARRS X, et al. The Acinetobacter baumannii oxymoron: commensal hospital dweller turned pan-drug-resistant menace[J]. Front Microbiol, 2012, 3: 148. DOI: 10.3389/fmicb.2012.00148.
 

更新日期/Last Update: 2019-04-05