Analysis On Clinical Characteristics, Drug Resistance And Risk Factors For Nosocomial Infection Of Acinetobacter Baumannii

BackgroundIn recent years, Acinetobacter baumanii nosocomial infection as the number one killer disease is becoming increasingly severe,while the clinical separation rate is higher than that of pseudomonas aeruginosa. Multiple resistance has become a huge challenge for medical workers, making much clinical medicine almost helpless. Although research about Acinetobacter baumanii attracts great attentions in the medical profession in recent years,because of the difference of regions, hospitals, periods, source of the disease, management system and exposure risk factors,the clinical characteristics, drug resistance and risk factors of Acinetobacter baumanii nosocomial infection are different. Therefore, really be so that we could give a instructive significance to clinical therapy,we need to do a research of Acinetobacter baumanii nosocomial infection in a region,a period even a hospital.ObjectiveThrough statistical analysis of the clinical features, the epidemic characteristics and the use of antibiotics about all the Acinetobacter baumanii isolated from Acinetobacter baumanii nosocomial infection,and design of retrospective case control study,we investigated the risk fators,analysed the current drug-resistance,in order to provide the reference of preventive measures,reducing the incidence rates,the clinical diagnosis and therapy.Methods1.Chose76cases of Acinetobacter baumannii strain isolated from Acinetobacter baumanii nosocomial infection in the the first affiliated hospital of Zhengzhou University from June in2010to December in2011,and collected the clinical data, builded Excel database table,investigated the clinical characteristics, drug-resistance of Acinetobacter baumanii nosocomial infection with the statistical software SPSS17.0.2.Chose46hospitalized patients with nosocomial infection while the pathogen was not the Acinetobacter baumannii in the first affiliated hospital of Zhengzhou University from June in2010to December in2011.Chose46cases to do1:1case control study from the76cases whose hospitalization time difference was less than7days,the same sex, same or similar diseases and the same ward. We firstly found out variables statistical significance by single factor analysis,and then discussed the independence hazard factors by many factors logistic regression analysis conditions.Results1.76cases of Acinetobacter baumannii strain mainly distributed in ICU(39,51.3%), neurosurgery department(9,11.9%), respiratory department(6,7.9%), neurology department(5,6.7%), geratology department (4,5.3%). Of these, lower respiratory tract infection were61cases,about80.3%,mainly were patients with advanced age(from60to80about26cases,34.2%), basic diseases(72,94.7%), using immunosuppressive drugs(46,60.5%), combination of antibiotics(60,78.9%), once ICU admission(49,64.5%), artificial airway(40,52.6%), branchofiberoscope(38,50%), and Invasive operation(39,51.3%).2. Of the76cases of Acinetobacter baumannii strain, cefotaxime was the most resistant,89.5%, polymyxin was the most sensitive,98.7%; MRAB were51cases, about67.1%;the resistance of third-generation cephalosporin was more than80%, while aminoglycosides and quinolones was more than70%,but the cefepime, a fourth generation cephalosporin was69.7%, relatively lower. The resistance of cefoperazone and sulbactam(9,11.8%)was lower than imipenem(44,57.9%) and meropenem (46,60.5%),what s more, intermediary rate(30,39.5%) was higher than imipenem(5,6.6%) and meropenem(7,9.2%).3. Single factor analysis showed that accepted artificial airway(OR=11.455), number of basic diseases(OR=8.077), combination of antibiotics(OR=7.273), using ventilator (OR=5.312), accepted branchofiberoscope(OR=5.224),usingimmunosupp--ressive drugs(OR=4.949), accepted invasive operation(OR=4.680), number of antibiotics(OR=4.026), length of antibiotics(OR=2.971) and once ICU admission (OR=2.292)were the10risk factors(all P<0.05). Many factors conditions logistic regression analysis pointed out that number of basic diseases(OR=5.667), accepted artificial airway(OR=5.250), using ventilator(OR=4.000),using immunosuppressive drugs(OR=3.750) and combination of antibiotics(OR=2.857)were the independence hazard factors(all P<0.05).ConclusionThe situation of Acinetobacter baumanii nosocomial infection is serious, with the increasingly serious drug resistance, and the risk factors of the basic diseases, the use of antibiotics, immunosuppressive drugs,ventilator and artificial airway.