摘要目的 探讨耐亚胺培南鲍曼不动杆菌医院获得性肺炎(HAP)的耐药性及危险因素.方法 回顾性分析2013年1月至2014年12月苏州市吴江区第一人民医院114例鲍曼不动杆菌HAP患者的资料.所有患者根据药物敏感性试验结果分为耐亚胺培南组和非耐亚胺培南组.比较两组对20种常用抗菌药物的耐药情况,并对耐亚胺培南组可能的危险因素进行Logistic多元回归分析.结果 114株鲍曼不动杆菌中,耐亚胺培南菌株66株(57.89％),非耐亚胺培南菌株48株(42.1 1％).耐亚胺培南鲍曼不动杆菌对β-内酰胺类、喹诺酮类及氨基糖苷类抗菌药物的耐药率均明显高于非耐亚胺培南组(P＜0.01).两组均未发现对替加环素耐药的菌株.单因素分析结果显示,急性生理与慢性健康评分(APACHEⅡ)≥15分、血浆白蛋白水平≤25 g/L、入住重症监护病房(ICU)、留置胃管、深静脉置管、人工气道的建立、机械通气时间≥7 d、广谱抗菌药物使用≥14 d,以及抗菌药物联合使用是耐亚胺培南鲍曼不动杆菌HAP发生的危险因素(x2=13.06、6.86、25.40、15.09、17.87、21.46、17.94、6.91和10.10,P＜0.01).多因素Logistic分析结果显示,人工气道的建立[OR=72.014,95％可信区间(CI):19.566 ～265.061,P＜0.01]、广谱抗菌药物使用≥14 d(OR=3.892,95％ CI:1.092～13.879,P＜0.05)为耐亚胺培南鲍曼不动杆菌HAP的独立危险因素.结论 耐亚胺培南鲍曼不动杆菌泛耐药现象严重,临床上应尽可能减少有创操作,严格控制抗菌药物长期和联合使用.

abstractsObjective To investigate the drug resistance and risk factors of hospital-acquired pneumonia (HAP) induced by imipenem-resistant Acinetobacter baumannii.Methods Clinical data on 114 patients with Acinetobacter baumannii-related HAPs admitted in Wujiang First People' s Hospital in Suzhou during January 2013 and December 2014 were retrospectively analyzed.According to the results of drug sensitivity test,patients were divided into imipenem-resistant group and non imipenem-resistant group.Drug resistance to 20 commonly used antibiotics was observed in two groups,and multivariate Logistic regression analysis was performed to identify the risk factors of imipenem-resistant Acinetobacter baumannii infection.Results Among 114 strains ofAcinetobacter baumannii,66 strains (57.89％) were imipenem-resistant and 48 strains (42.11％) were non-imipenem-resistant.The resistance rates to β-lactams,quinolones and aminoglycosides were significantly higher in imipenem-resistant group than those in non-imipenem-resistant group (P ＜ 0.01),and no tigecycline-resistant strain was found in both groups.Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥ 15,plasma level of albumin ≤ 25 g/L,intensive care unit (ICU) stay,indwelling gastric tube,deep venous catheterization,establishment of artificial airway,mechanical ventilation time ≥ 7 d,use of broad-spectrum antibiotics ≥ 14 d and combined use of antibiotics were risk factors of imipenem-resistant Acinetobacter baumannii related HAP (x2 =13.06,6.86,25.40,15.09,17.87,21.46,17.94,6.91 and 10.10,P ＜0.01).Multivariate Logistic regression analysis revealed that establishment of artificial airway [OR =72.014,95％ confidetial interval (CI):19.566-265.061,P ＜ 0.01],and use of broad-spectrum antibiotics ≥ 14 d (OR =3.892,95％ CI:1.092-13.879,P ＜ 0.05) were independent risk factors of imipenem-resistant Acinetobacter baumannii related HAP.Conclusion Imipenem-resistant Acinetobacter baumannii strains are highly resistant to most antibiotics.Strict control of invasive procedures and long-term combined use of antibiotics may reduce the occurrence of imipenem-resistant Acinetobacter baumannii related HAPs.