神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析

符佩姝; 孙凤军; 冯伟; 李晓宇; 夏培元

doi:10.16016/j.1000-5404.201811218

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神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析

临床医学 | 更新时间：2026-01-09

- 神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析
- Drug resistance of Acinetobacter baumannii and risk factors of its infection in neurosurgery
- 第三军医大学学报 2019年41卷第7期页码：706-711
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院药学部
  2.056001 河北邯郸，解放军第980医院邯郸分院药剂科
- 作者简介：
  
  [ 夏培元，E-mail: py_xia2013@163.com XIA Peiyuan, E-mail: py_xia2013@163.com
- 基金信息：
  
  陆军军医大学第一附属医院军事医学科技创新计划(SWH2017JCZD-04)
- DOI：10.16016/j.1000-5404.201811218
  中图分类号： R378.7;R651;R915
- 收稿：2018-11-29，
  
  修回：2019-02-02，
  
  纸质出版：2019-04-15
- 稿件说明：
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符佩姝, 孙凤军, 冯伟, 等. 神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析[J]. 第三军医大学学报, 2019,41(7):706-711.

Peishu FU, Fengjun SUN, Wei FENG, et al. Drug resistance of Acinetobacter baumannii and risk factors of its infection in neurosurgery[J]. Journal of Third Military Medical University, 2019, 41(7): 706-711.
符佩姝, 孙凤军, 冯伟, 等. 神经外科鲍曼不动杆菌的耐药性及其感染的危险因素分析[J]. 第三军医大学学报, 2019,41(7):706-711. DOI： 10.16016/j.1000-5404.201811218.

Peishu FU, Fengjun SUN, Wei FENG, et al. Drug resistance of Acinetobacter baumannii and risk factors of its infection in neurosurgery[J]. Journal of Third Military Medical University, 2019, 41(7): 706-711. DOI： 10.16016/j.1000-5404.201811218.

摘要

目的

分析神经外科鲍曼不动杆菌的耐药性及感染鲍曼不动杆菌的危险因素。

方法

选取2017年陆军军医大学第一附属医院神经外科感染鲍曼不动杆菌的病例62例，用琼脂倍比稀释法测定临床常用抗菌药物对鲍曼不动杆菌的最小抑菌浓度；采用病例对照的研究方法，选择同期细菌培养为非鲍曼不动杆菌感染的病例174例为对照组，收集临床数据，应用单因素分析及多因素Logistic回归分析感染鲍曼不动杆菌的危险因素。

结果

鲍曼不动杆菌对临床常用的抗菌药物除左氧氟沙星外耐药率均大于50%。单因素分析发现神经外科感染鲍曼不动杆菌的危险因素包括：年龄，感染前住院时间≥14 d，感染前入住ICU时间≥7 d，格拉斯哥昏迷评分(GSC评分)≤8分，急性生理与慢性健康评分(APACHEⅡ评分)≥20分，感染前4代头孢、β-内酰胺类加酶抑制剂、碳青霉烯类、替加环素的使用，机械通气及留置胃管。多因素回归分析结果显示：感染前入住ICU时间≥7 d(

=4.179，95%

：1.638~10.662)、APACHEⅡ评分≥20分(

=5.798，95%

：1.695~19.829)、机械通气(

=3.726，95%

：1.571~8.840)及感染前β-内酰胺类加酶抑制剂的使用(

=3.709，95%

：1.353~10.168)为神经外科患者鲍曼不

动杆菌感染的独立危险因素。

结论

鲍曼不动杆菌对临床常用的抗菌药物耐药率高，感染前入住ICU时间≥7 d、APACHEⅡ评分≥20分、机械通气及感染前使用β-内酰胺类加酶抑制剂为神经外科患者鲍曼不动杆菌感染的独立危险因素。

Abstract

Objective

To investigate the drug resistance and the risk factors infected by

Acinetobacter baumannii

(

A. baumannii

) in neurosurgery.

Methods

A total of 62 cases with

A. baumannii

infection admitted in the neurosurgery of our hospital during January and December 2017 were enrolled in this study. The minimum inhibitory concentrations of common antibacterial drugs against

A. baumannii

were determined by agar dilution. The case-control study method was used to select the 174 non-

A. baumannii

infection cases as the control group

and their clinical data were collected. The risk factors of

A. baumannii

infection were analyzed by univariate analysis and multivariate logistic regression.

Results

A. baumannii

strains were much higher resistant to clinically used antibacterial drugs

except levofloxacin

with the resistant rates were more than 50%. Univariate analysis found that age

pre-infection length of hospital stay ≥14 d

ICU length before infection ≥7 d

GSC score≤8

APACHEⅡ score≥20

usages of 4th generation of cephalosporins

β-lactam enzyme inhibitor

carbapenems and tigecycline before infection

and mechanical ventilation and indwelling gastric tube were risk factors for

A. baumannii

infection in neurosurgery (

0.05). Multivariate regression analysis showed that the length of ICU stay before infection ≥7 d (

=4.179

95%

: 1.638~10.662)

APACHEⅡ score≥20 (

=5.798

95%

: 1.695~19.829)

mechanical ventilation (

=3.726

95%

: 1.571~8.840) an

d the usage of β-lactam enzyme inhibitors before infection (

=3.709

95%

: 1.353~10.168) were independent risk factors for the patients with

A. baumannii

infection in neurosurgery.

Conclusion

The resistance rate of

A. baumannii

in neurosurgery is quite high. The length of ICU stay before infection ≥7 d

APACHEⅡ score ≥20

mechanical ventilation and usage of β-lactam enzyme inhibitors before infection are independent risk factors for

A. baumannii

infection in neurosurgery.

关键词

Keywords

references

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