耐碳青霉烯鮑曼不動桿菌醫院獲得性肺炎的危險因素及預后分析_《中國呼吸與危重監護雜志》

作者：

盧健聰 ¹ ,  蔡紹曦 ¹ , 耿穗娜 ² , 佟萬成 ¹ , 馬真 ¹ , 孟瑩 ¹ , 劉來昱 ¹

1 南方醫科大學南方醫院呼吸科（廣東廣州 510515）;;
2 南方醫科大學南方醫院檢驗科（廣東廣州 510515）;

關鍵詞：

鮑曼不動桿菌醫院獲得性肺炎耐碳青霉烯危險因素預后因素

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目的探討耐碳青霉烯的鮑曼不動桿菌( CRAB) 醫院獲得性肺炎的危險因素及預后因素。方法采用病例對照研究, 收集廣州南方醫院2005 年1 月～2007 年12 月CRAB 引起的醫院獲得性肺炎44 例, 并隨機選擇同時期碳青霉烯敏感的鮑曼不動桿菌( CSAB) 醫院獲得性肺炎66 例作為對照, 采用單因素分析( t 檢驗和　2 檢驗) 及多因素Logistic 回歸進行分析。結果單因素分析發現, APACHEⅡ評分≥16分、慢性肺部疾病( COPD/支氣管擴張) 、分離出致病菌前15 d 用過亞胺培南/ 美羅培南、氟　諾酮類抗生素以及早期聯用抗生素與CRAB 感染有關。多因素Logistic 回歸分析發現, APACHEⅡ評分≥16 分( OR=6. 41, 95% CI 2. 20 ～18. 67) 以及分離出致病菌前15 d 用過亞胺培南/ 美羅培南( OR = 6. 33, 95% CI 1. 83 ～21. 87) 是獨立危險因素。44 例感染CRAB 患者中, 死亡14 例, 存活30 例。單因素分析發現: 臟器衰竭以及治療3 d 后臨床肺部感染評分( CPIS) 升高與CRAB 感染死亡有關。多因素Logistic 回歸分析發現, 治療3 d 后CPIS升高( OR=7. 01, 95% CI 1. 23 ～40. 03) 是獨立預后因素。結論 APACHEⅡ評分≥16 分以及分離出CRAB 前15 d 用過亞胺培南/美羅培南是CRAB 感染的危險因素。治療3 d 后CPIS 升高是CRAB感染的預后因素。

引用本文： 盧健聰,蔡紹曦,耿穗娜,佟萬成,馬真,孟瑩,劉來昱. 耐碳青霉烯鮑曼不動桿菌醫院獲得性肺炎的危險因素及預后分析. 中國呼吸與危重監護雜志, 2009, 09(1): 24-28. doi: 復制

1.	A report from the NNIS System. National Nosocomial Infections Surveillance(NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control, 2003,31: 481-498.
2.	Corbella X, Montero A, Pujol M, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. JClin Microbiol, 2000, 38:4086 -4095.
3.	Manikal VM, Landman D, Saurina G, et al. Endemic carbapenen-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and retion to antibiotic usage. Clin Infect Dis, 2000, 31: 101-106.
4.	中華人民共和國衛生部. 醫院感染診斷標準( 試行) . 中華醫學雜志, 2001, 81: 314-320.
5.	Wong TH, Tan BH, Ling ML, et al. Multi-resistant Acinetobacter baumannii on a burns unit— clinical risk factors and prognosis. Burns,2002, 28: 349-357.
6.	Gales AC, Jones RN, Forward KR, et al. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program ( 1997-1999) . Clin Infect Dis, 2001, 32: S104-S113.
7.	劉朝暉, 陳勁龍, 謝長江, 等. 廣州地區呼吸機相關性肺炎臨床流行病學和病原學分析. 中國呼吸與危重監護雜志, 2007, 6:93-96.
8.	曹彬. 多藥耐藥革蘭陰性菌肺炎的抗感染治療. 中國呼吸與危重監護雜志, 2008, 7: 3-5.
9.	Cunnion KM,Weber DJ, Hanson LC, et al. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med, 1996, 153: 158-162.
10.	Lee SO, Kim NJ, Choi SH, et al. Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case-control study. Antimicrob Agents Chemother, 2004, 48: 224-228.
11.	Cunha BA. Effective antibiotic-resistance control strategies. Lancet,2001, 357: 1307-1308.
12.	Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Crit Care, 2006, 10: R48.
13.	Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilatorassociated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med, 2003 , 31: 676 -682.
14.	楊國輝, 王廣發. 臨床肺部感染評分對呼吸機相關肺炎患者預后的評價. 中華結核和呼吸雜志, 2006, 29: 751-754.
15.	姜輝, 俞森洋. 臨床肺感染評分診斷通氣機相關肺炎. 中華醫院感染學雜志, 2005, 15: 751-752.

1. A report from the NNIS System. National Nosocomial Infections Surveillance(NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control, 2003,31: 481-498.
2. Corbella X, Montero A, Pujol M, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. JClin Microbiol, 2000, 38:4086 -4095.
3. Manikal VM, Landman D, Saurina G, et al. Endemic carbapenen-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and retion to antibiotic usage. Clin Infect Dis, 2000, 31: 101-106.
4. 中華人民共和國衛生部. 醫院感染診斷標準( 試行) . 中華醫學雜志, 2001, 81: 314-320.
5. Wong TH, Tan BH, Ling ML, et al. Multi-resistant Acinetobacter baumannii on a burns unit— clinical risk factors and prognosis. Burns,2002, 28: 349-357.
6. Gales AC, Jones RN, Forward KR, et al. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program ( 1997-1999) . Clin Infect Dis, 2001, 32: S104-S113.
7. 劉朝暉, 陳勁龍, 謝長江, 等. 廣州地區呼吸機相關性肺炎臨床流行病學和病原學分析. 中國呼吸與危重監護雜志, 2007, 6:93-96.
8. 曹彬. 多藥耐藥革蘭陰性菌肺炎的抗感染治療. 中國呼吸與危重監護雜志, 2008, 7: 3-5.
9. Cunnion KM,Weber DJ, Hanson LC, et al. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med, 1996, 153: 158-162.
10. Lee SO, Kim NJ, Choi SH, et al. Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case-control study. Antimicrob Agents Chemother, 2004, 48: 224-228.
11. Cunha BA. Effective antibiotic-resistance control strategies. Lancet,2001, 357: 1307-1308.
12. Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Crit Care, 2006, 10: R48.
13. Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilatorassociated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med, 2003 , 31: 676 -682.
14. 楊國輝, 王廣發. 臨床肺部感染評分對呼吸機相關肺炎患者預后的評價. 中華結核和呼吸雜志, 2006, 29: 751-754.
15. 姜輝, 俞森洋. 臨床肺感染評分診斷通氣機相關肺炎. 中華醫院感染學雜志, 2005, 15: 751-752.

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耐碳青霉烯鮑曼不動桿菌醫院獲得性肺炎的危險因素及預后分析

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