【摘要】 目的探讨耐碳青霉烯的鲍曼不动杆菌(CRAB)医院获得性肺炎的危险因素及预后因素。方法采用病例对照研究,收集广州南方医院2005年1月~2007年12月CRAB引起的医院获得性肺炎44例,并随机选择同时期碳青霉烯敏感的鲍曼不动杆菌(CSAB)医院获得性肺炎66例作为对照,采用单因素分析(t检验和2检验)及多因素Logistic回归进行分析。结果单因素分析发现,APACHEⅡ评分≥16分、慢性肺部疾病(COPD支/气管扩张)、分离出致病菌前15 d用过亚胺培南/美罗培南、氟喹诺酮类抗生素以及早期联用抗生素与CRAB感染有关。多因素Logistic回归分析发现,APACHEⅡ评分≥16分(OR=6.41,95%CI2.20~18.67)以及分离出致病菌前15 d用过亚胺培南/美罗培南(OR=6.33,95%CI1.83~21.87)是独立危险因素。44例感染CRAB患者中,死亡14例,存活30例。单因素分析发现:脏器衰竭以及治疗3 d后临床肺部感染评分(CPIS)升高与CRAB感染死亡有关。多因素Logistic回归分析发现,治疗3 d后CPIS升高(OR=7.01,95%CI1.23~40.03)是独立预后因素。结论APACHEⅡ评分≥16分以及分离出CRAB前15 d用过亚胺培南/美罗培南是CRAB感染的危险因素。治疗3 d后CPIS升高是CRAB感染的预后因素。更多还原

【Abstract】 Objective To study the risk factors and prognosis of hospital acquired pneumonia(HAP) caused by carbapenem-resistant Acinetobacter baumannii(CRAB).Methods By a case-control study,the data of 44 cases of HAP caused by CRAB from Jan 2005 to Dec 2007 in Nanfang Hospital were analyzed.66 cases of HAP caused by Carbapenem-susceptible A.baumannii(CSAB) were selected randomly at the same time as control.Univariate analysis(T test and chi-square test) and multivariate logistic regression were used for statistics analysis.Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHEⅡ score≥16,chronic pulmonary disease(COPD/bronchiectasis),imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB,and early combination therapy of antibiotics.Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16(OR=6.41,95%CI 2.20-18.67)and imipenem/meropenem used 15 days before isolation of CRAB(OR=6.33,95%CI 1.83-21.87).Of 44 cases of CRAB infections,14 patients died and 30 patients survived.Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score(CPIS) rise after three-day treatment.According to multivariate logistic regression analysis,only CPIS rise after three-day treatment(OR=7.01,95%CI 1.23-40.03) was an independent predictive factor.Conclusions APACHEⅡ score ≥16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection.CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.更多还原