儿科重症监护室27例广泛耐药鲍曼不动杆菌医院获得性肺炎的危险因素分析被引量：27

Analysis of Risk Factors of 27 Cases of Hospital Acquired Pneumonia Caused by Pandrug-resistant Acinetobacter baumannii in the Pediatric Intensive Care Unit

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摘要目的探讨儿童广泛耐药鲍曼不动杆菌(PDRAb)医院获得性肺炎的危险因素,为临床防治PDRAb感染提供依据。方法收集2010.10.1～2011.9.31重庆儿童医院儿科重症监护室(PICU)收治的89例鲍曼不动杆菌(Ab)医院获得性肺炎患儿的临床资料,并对发生PDRAb的危险因素进行单因素分析和多元Logistic回归分析。结果 89例中有27例为PDRAb感染,年龄最大13岁,最小4个月,中位年龄25.0(7.0～56.0)月;PDRAb组PICU住院总天数、机械通气总天数、死亡率均明显高于non-PDRAb组[分别为(20.74±13.76)d vs.(13.39±7.63)d、(14.16±9.85)d vs.(9.46±7.16)d、18.5%vs.4.8%,均P<0.05];多元Logistic回归分析显示Ab感染前机械通气天数(OR=3.25)、PICU住院天数(OR=5.91)、抗生素使用天数(OR=2.76)和使用碳青酶烯类抗生素(OR=5.37)是PDRAb医院获得性肺炎独立危险因素。结论 PDRAb感染治疗困难,死亡率高。早期识别PDRAb感染的危险因素,合理使用抗菌药物,加强微生物学监测,防止院内交叉感染,是预防和控制PDRAb感染发生和蔓延的关键。 Objective To study the risk factors for hospital acquired pneumonia（HAP） caused by pandrug-resistant Acine- tobacter baumannii（PDRAb） and offer strategies for the prevention and control of PDRAb infection. Methods Clinical data of 89 patients who were diagnosed as having HAP and treated in the Pediatric Intensive Care Unit （PICU） of Chongqing Children＇s Hospital from Oct 1,2010 to Sept 31,2011 in the PICU were retrospectively analyzed. The risk factors of PDRAb- caused HAP were obtained by using univariate and multivariate stepwise Logistic regression analysis. Results Among the 89 patients, 27 （30.34 %） were identified to have PDRAb-caused HAP, including 15 males and 12 females. Their age ranged from 4 months to 13 years（median age： 25. 0 months）. The average PICU stay[（20. 74 ±13.76） days], the average time for mechanic ventilation[（14.16±9.85）days] ,and in-hospital mortality rate（18. 5%） were much higher in PDRAb group than those in non- PDRAb group[（13. 39±7.63）days, （9.46±7.16）days,4.8% ,respectively,all P〈0.05]. Logistic regression analysis showed that the time for mechanic ventilation before PDRAb infection（OR = 3.25）, the PICU stay（OR = 5.91）, the antibiotic use time （OR=2.76） and the administration of carbapenems（OR=5.37） prior to PDRAb infection were the independent risk factors as- sociated with PDRAb-caused HAP. Conclusion Early recognition of the high-risk factors for PDRAb infection,the rational use of antibiotics,improvement of microbiological monitoring,and prevention of nosocomial cross infection are the key to prevention and control of PDRAb infection.

作者刘成军龙江海李静许峰

机构地区重庆医科大学附属儿童医院重症医学科湖北省当阳市人民医院儿科

出处《华中科技大学学报（医学版）》 CAS CSCD 北大核心 2013年第2期219-222,共4页 Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

关键词鲍曼不动杆菌危险因素医院获得性肺炎 Acinetobacter baumannii risk factors hospital acquired pneumonia（HAP）

分类号 R563.11 [医药卫生—呼吸系统]

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