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目的探讨重症监护病房(ICU)多重耐药鲍曼不动杆菌(Ab)感染的危险因素。方法以180例确诊Ab感染的ICU患者作为研究对象,将72例多重耐药Ab感染患者作为多重耐药组,将108例非多重耐药Ab感染患者作为非多重耐药组,对两组患者的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯性器官功能衰竭(SOFA)评分、手术、侵入性操作、抗生素使用情况及分离出的Ab菌株的耐药性进行观察和比较。采用SPSS 17.0统计软件进行统计分析,计量资料用均数±标准差(xˉ±s)表示,采用t检验,计数资料用率(%)表示,采用χ~2检验,多因素Logistic回归方法进行相关性分析。P<0.05为差异有统计学意义。结果多重耐药组患者的APACHEⅡ评分、SOFA评分及行气管插管/切开、应用第三代头孢、应用碳青霉烯类抗生素、抗生素使用时间>7 d的患者比例均高于非多重耐药组(t=4.508、2.967,χ~2=8.585、13.594、7.642、6.136,P<0.05);多因素Logistic回归分析结果显示,应用第三代头孢(OR=3.425)、感染前APACHEⅡ(OR=1.246),感染前SOFA评分(OR=1.716)、行气管切开/插管(OR=2.657)与多重耐药鲍曼不动杆菌感染呈正相关关系(OR=3.425、1.246、1.716、2.657,P<0.05)。结论在ICU患者中分离出的Ab菌株的耐药性较高,较差的健康状态和器官功能、抗生素的不合理应用和气道侵入性操作是发生多重耐药Ab感染的独立危险因素。
Objective To investigate the risk factors of multiple drug-resistant Acinetobacter baumannii (Ab) in intensive care unit (ICU). Methods One hundred and eighty patients with ICU diagnosed with Ab infection were selected as study objects. 72 patients with multiple drug-resistant Ab infection as multi-drug resistant group and 108 non-multi-drug resistant Ab patients as non-multi-drug resistant group. APACHE II score, sequential organ failure (SOFA) score, operation, invasive procedure, antibiotic use and antibiotic resistance of isolated Ab strains were observed and compared. Statistical analysis was performed by using SPSS 17.0 statistical software. The measurement data were expressed as mean ± standard deviation (x ± s), t test was used, and the data usage rate (%) was expressed as a percentage. Logistic regression analysis was used to test the correlation Sexual analysis. P <0.05 for the difference was statistically significant. Results APACHEⅡscore, SOFA score and endotracheal intubation / incision in multidrug resistance group were higher than those in non-multi-resistant group with third generation cephalosporins, carbapenems antibiotics and antibiotics> 7 days The results of multivariate Logistic regression analysis showed that the third generation of cephalosporins (OR = 3.425) and APACHEⅡ (OR = 3.425) = 1.246), SOFA score before infection (OR = 1.716), tracheotomy / intubation (OR = 2.657) and multidrug-resistant Acinetobacter baumannii infection were positively correlated (OR = 3.425,1.246,1.716,2.657, P <0.05). Conclusions Ab strains isolated from patients with ICU have higher drug resistance, poorer health status and organ function, irrational use of antibiotics and invasive airway disease as independent risk factors for multi-drug resistant Ab infection.