| 摘要: |
| 目的 了解亚胺培南耐药鲍曼不动杆菌（CRAB）医院感染的危险因素，并探讨Ⅰ类整合子在鲍曼不动杆菌亚胺培南耐药中的作用。方法 选取确诊为CRAB 医院感染患者54 例作为病例组，按1:3 配对选择162 例亚胺培南敏感鲍曼不动杆菌（CSAB）医院感染患者作为对照组，采用单因素分析及多因素logistic 回归分析其危险因素，PCR 检测Ⅰ类整合酶基因。结果 单因素分析发现，与CRAB 医院感染相关的危险因素有病情危重、入住ICU 时间、住院时间≥14d、机械通气/ 人工气道、留置尿管、中心静脉置管、免疫抑制剂的使用、抗生素使用时间≥7d、抗生素药物种类≥3 种。多因素logistic回归分析发现，病情危重（OR:8.47;95% CI:1.56～46.0）、入住ICU 时间（OR:9.32; 95% CI:1.83～47.43）、住院天数≥14d（OR:13.89;95% CI:3.07～62.85）、机械通气/ 人工气道（OR:18.86; 95% CI:4.38～81.31）、抗生素使用种类≥3 种（OR:6.16;95% CI:1.85～20.51）、抗生素使用时间≥7d（OR:5.41; 95% CI: 1.36～21.58）是CRAB 医院感染的独立危险因素；CRAB 组中Ⅰ类整合酶基因检出率（59.3%）显著高于CSAB 组（34.6%），差异有统计学意义（P＜0.001）。结论 病情危重、入住ICU 时间、住院时间、机械通气/ 人工气道、抗生素使用种类≥3种、抗生素使用时间≥7d 是CRAB 医院感染的独立危险因素，Ⅰ类整合子在CRAB 中普遍存在，需加强对相关危险因素的控制及耐药机制的研究，早期防治CRAB 医院感染的发生。 |
| 关键词: 亚胺培南耐药鲍曼不动杆菌 医院感染 危险因素 Ⅰ类整合子 |
| DOI： |
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| Risk factors for nosocomial infections caused carbapenem-resistant Acinetobacter Baumanii（CRAB）: a case-control study |
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YE Jihui,LI Chaofen,DING Qunli
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Ningbo First Hospital
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| Abstract: |
| Objective To investigate the risk factors for nosocomial infections caused by carbapenem-resistant Acinetobacter Baumanii(CRAB). Methods Fifty-four patients with nosocomial infection by CRAB(cases) and162matched patients with nosocomial infection by carbapenem-susceptible Acinetobacter Baumanii (CSAB) as controls admitted in hospital from January 2012 to December 2012 were includedin the study. Univariate analysis and multivariate logistic regression were used to analyze the risk factors for nosocomial infection by CSAB. Class Ⅰintegron was detected by PCR. Results Univariate analysis revealed that the risk factors for nosocomial infection by CRAB were pathogenetic condition, ICU stay, hospitalization≥14d, mechanical ventilation/artificial airway, urinary catheter, central venous catheter, administration of immunosuppressive agents, treatment with≥3 kinds of antibiotics and ≥7d．Multivariate logistic regression analysis identified six independent risk factors: pathogenetic condition(OR 8.47; 95%CI 1.56～46.0), ICU stay (OR 9.32; 95%CI 1.83～47.43), hospitalization≥14d (OR 13.89;95%CI 3.07～62.85), mechanical ventilation/artificial airway (OR 18.86; 95%CI 4.38～81.31), treatment with≥3 kinds of antibiotics(OR 6.16; 95%CI 1.85～20.51) and≥7d (OR 5.41; 95%CI 1.36～21.58). Detection rate of classⅠintegron among CRAB was significantly higher than that in CSAB(59.3% vs 34.6%, P＜0.001). Conclusion Pathogenetic condition, ICU stay, hospitalization≥14d, mechanical ventilation/artificial airway,treatment with more than 3 kinds of antibiotics, using antibiotics≥7d are likely to be risk factors for nosocomial infection by CRAB,andClassⅠintegronare common in the CRAB. |
| Key words: Carbapenem-resistant acinetobacter baumanii Nosocomial infection Risk factors ClassⅠ integron |
