Clinical Analysis Of Patients And Risk Factors On Mortality With Acinetobacter Baumannii Bloodstream Infection

Clinical analysis of patients with Acinetobacter baumannii bloodstream infectionObjective:To explore the clinical feature and drug resistance of A.baumannii bloodstream infection.Methods:Retrospective cohort study of patients with A.baumannii bloodstream infection hospitalized From January 2010 to November 2011.Results:Distribution department for 37 cases in the ICU patients after admission,the hot section of 17 cases,13 cases of onset,6 cases of renal diseases,general surgery(3 cases),brain surgery in 2 cases,the difference was statistically significant(P<0.05).66 cases in patients undergoing central venous catheter(84.6%),and 44 patients with invasive mechanical ventilation(56.4%),and surgical treatment of 43 cases(55.1%)patients,blood purification treatment of 16 cases(20.5%)patients,line 11 patients with fiber bronchoscope alveolar lavage(14.1%).Line 4 cases(5.1%)patients with closed drainage of the chest,patients with arteriovenous fistula plasty in artificial in 2 cases(3.8%),peritoneal colostomy patients in 1 case(1.3%).Central venous catheter compared with other invasive operation,the difference was statistically significant(P<0.05).78 patients in all 23 cases of drug-resistant acinetobacter baumannii(29.5%),multiple drug resistant acinetobacter baumannii 55 cases(70.5%).Imine southern culture,beauty e.faecalis,ofloxacin,amikacin,cefoperazone/shu ba jotham the resistant rate of 84.6%,84.6%,75.6%,71.8%,65.4%.Conclusions:Blood culture of acinetobacter baumannii patients often with poor general condition,the primary disease is severe,more distribution in ICU.Center venipuncture patients showed signs of infection,high alert center of catheter-related bloodstream infection.Total resistance,extensively drug-resistant or multiple drug resistance of acinetobacter baumannii blood-borne infection detection rate is high,the reasonable application of antimicrobial agents should be strengthened.Part ? Analysis of Risk Factors on mortality of Acinetobacter baumannii bloodstream infectionObjective:To explore the risk factors on mortality of Acinetobacter baumannii bloodstream infection.Methods:Clinical data of 36 patients with A.baumannii bacteraemia hospitalized from January 2010 to November 2012 were analyzed retrospectively.According to the 28-day mortality after admission,the patients were divided into nonsurviors(19cases)and survivors(17 cases).Data on demographic and clinical characteristics,wards,underlying diseases,treataients,invasive medical procedures,drug resistance,and APACHIE? score in the beginning were accumulated.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.The predictorvalue was concluded by comparing area under the receiver operating characteristic curve(ROC curve)of each index.Results:78 cases of patients with bloodstream infections,secondary to 33 cases of lower respiratory tract infection(42.3%),deep venipuncture in 19(24.4%),primary infection focal unknown 14 cases(17.9%),other infected site including 12 cases of surgical wound(15.4%).Death group of bloodstream infections in the ICU ratio is higher than the ICU patients,the difference was statistically significant(p<0.05).Compared with the survivors,such data were associated with increased mortality:wards admitted in ICU(OR=12.9,95%CI [2.4?63.5],p= 0.001),trachea intubed or tracheostomy(OR=6.2,95%CI [1.5 ?30.4],p =0.023),invasive mechanical ventilation(OR=5.1,95%CI [1.4?22.6],p= 0.042),invasive medical procedure besides central venous catheter(including thoracentesis,bone marrow puncture,lumbar puncture,catheterization5 bronchoalveolar lavage with bronchofibroscope,arteriovenous fistula in shape;OR=8.4,95%CI [1.7~37.8],77=0.011),score of APACHIEII >19 in the beginning(OR=35.4,95%CI [3.8?318.6],p =0.001).In a multivariate stepwise logistic regression model,the score of APACHIEII ? 19 was a strong predictor of adverse outcome after Acinetobacter baumannii bloodstream infection.With respect to the score of APACHIE ? ? 19 as mortality cut-off point,an area under the receiver operating curve of 0.938 was statistically significant(p < 0.05),with sensitivity 76.2% and specificity94.1%.The relationship between prognosis and antibiotic resistance did not have statistically significance.Conclusions:Invasive medical procedures and treataents would be associated with increased mortality of patients with A.baumannii bacteraemia.A strong predictor of adverse outcome in such conditions was the score of APACHIE II ^19.Measures as to control the primary disease,to reduce unnecessary invasive operation,to block transmission of acinetobacter baumannii,to abide by the aseptic operation and infection control practices strictly,to strengthen antibacterial drugs in clinical management?such as this can delay and reduce the generation of drug resistance of acinetobacter baumannii bloodstream infections.For further genotyping of acinetobacter baumannii complex,can be efifective for genotyping of pathogens and(frug resistance degree,including taking Sulbactamof beta lactam antibiotics combined anti-infective relatively suitable for empiric treatment.