鲍曼不动杆菌血流感染预后不良的危险因素
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沈宁

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Risk factors for poor prognosis of bloodstream infection caused by Acinetobacter baumannii
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    摘要:

    目的分析影响鲍曼不动杆菌血流感染患者预后的相关因素,指导临床预防及治疗。 方法采用病例对照的研究方法,回顾性分析2012年1月—2016年12月北京大学第三医院鲍曼不动杆菌血流感染患者,依据预后情况将患者分为预后不良组和预后良好组。应用单因素及logistic回归分析鲍曼不动杆菌血流感染患者预后不良的危险因素。结果共有鲍曼不动杆菌感染确诊病例58例,其中预后不良组31例,预后良好组27例。单因素分析结果表明,入院前3个月使用过抗菌药物、使用抗菌药物≥2种,住院后感染前使用抗菌药物≥2种、使用碳青霉烯类抗生素,感染后血白细胞计数升高均是鲍曼不动杆菌血流感染患者预后不良的危险因素(P<0.05)。抗感染治疗3 d后预后良好组的血白细胞计数、X线胸片情况均显示好转,优于预后不良组(P<0.05)。Logistic多因素回归分析表明,入院前3个月内使用过抗菌药物,入院后感染前使用抗菌药物≥3种、使用碳青霉烯类抗生素,感染后白细胞计数升高、白细胞计数>12×109/L,抗感染治疗3 d后白细胞计数升高、白细胞数计数>15×109/L均是鲍曼不动杆菌血流感染预后不良的独立危险因素(P<0.05)。结论鲍曼不动杆菌感染患者预后不良概率高。对于入院前3个月内使用抗菌药物≥2种、入院后感染前使用抗菌药物≥3种、使用过碳青霉烯类抗生素的患者,要警惕鲍曼不动杆菌血流感染预后不良的可能性。对于感染后血白细胞计数>12×109/L、治疗3 d后血白细胞计数>15×109/L的患者要警惕预后不良的发生,及时调整治疗方案,降低病死率。

    Abstract:

    ObjectiveTo analyze related factors affecting the prognosis of patients with Acinetobacter baumannii(A. baumannii) bloodstream infection(BSI), guide clinical prevention and treatment.MethodsA casecontrol study was conducted to retrospectively analyze patients with A. baumannii BSI in Peking University Third Hospital from January 2012 to December 2016. According to prognosis, patients were divided into poor prognosis group and good prognosis group. Univariate analysis and logistic regression analysis were used to analyze the risk factors of poor prognosis in patients with A. baumannii BSI.ResultsThere were 58 confirmed cases of A. baumannii BSI, including 31 patients with poor prognosis and 27 with good prognosis. Univariate analysis revealed that risk factors for poor prognosis of A . baumannii BSI were antimicrobial use and at least two kinds of antimicrobial agent use three months before admission, at least two kinds of antimicrobial use, and carbapenems use before infection after admission, increase of white blood cell (WBC) count after infection(P<0.05). After 3day antiinfective treatment, examination results of WBC count and Xray chest film in good prognosis group were all better than poor prognosis group(P<0.05). Logistic multivariate regression analysis showed that independent risk factors for poor prognosis of A. baumannii BSI were antimicrobial use three months before admission, at least three kinds of antimicrobial use and carbapenem use before infection after admission, increase of WBC count and WBC count>12×109/L after infection,as well as increase of WBC count and WBC count>15×109/L after 3day antiinfective treatment(P<0.05).ConclusionThe probability of poor prognosis is high in patients with A. baumannii infection. For patients receiving≥2 kinds of antimicrobial agents three months before admission, patients receiving≥3 kinds of antimicrobial agents as well as patients receiving carbapenems before infection after admission, the likelihood of A . baumannii BSI should be paid attention. For patients with WBC count>12×109/L after infection and WBC count>15×109/L after 3day treatment, poor prognosis should be alerted, treatment plan needs to be adjusted in time to reduce the mortality.

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胡宇晴, 马新然, 冒文君,等.鲍曼不动杆菌血流感染预后不良的危险因素[J]. 中国感染控制杂志,2018,17(4):329-334. DOI:10.3969/j. issn.1671-9638.2018.04.011.
HU Yuqing, MA Xinran, MAO Wenjun, et al. Risk factors for poor prognosis of bloodstream infection caused by Acinetobacter baumannii[J]. Chin J Infect Control, 2018,17(4):329-334. DOI:10.3969/j. issn.1671-9638.2018.04.011.

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  • 收稿日期:2017-07-12
  • 最后修改日期:2017-09-08
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  • 在线发布日期: 2018-04-26
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