Acinetobacter Baummannii As NICU Nosocomial Athogens:Present Situation Investigation And Counter-measures

Object：1. To investigate on Acinetobacter baummanii nosocomial infection of NICU.2. To study on the counter-measures of NICU Acinetobacter baummanii nosocomialinfection.Methods：1. The patients with A.baummanii(Acinetobacter baummanii) nosocomial infectionfrom NICU of the Second Affiliated Hospital of SuZhou University were surveyedbetween January2010and December2011. Drug sensitivity of A.baummanii was analyzed.And a case control comparison was performed to identify risk factors.2. Infection management system including bedside isolation, terminal disinfectionwas established and applied. The A.baummanii detection parts and infection rates werecompared before and after the application of infection management system.3. Choosing sensitive antibiotics, strengthening nutritional support and application offiber bronchoscope were performed in pulmonary infection cases. Early injection ofsensitive antibiotics intravenously and intraventricularly or intrathecally as well asventricular cistern drainage or lumber cistern drainage were performed in CNS infectioncases. The treatment causes of patients were analyzed, and effective therapies weresummarized.Results：1. Totally865patients were investigated, and205of them were nosocomially infected.Nosocomial infection rate was23.70%.90cases were A.baummanii infected, and infectionrate was10.40%. The involved sites of infection were lung and CNS. The rates of MDR and PDR were84.44%. The rates of A.baummanii resistant to various antibiotics were over50％in vitro susceptibility test.2. The independent risk factors were: GCS(OR=5.57), albumin level(OR=1.73),drainage tube existence over average time(OR=1.40).3. After strictly following the infection control system，the rate of A.baummaniipositive surfaces in the environment decreased from87.50%to12.50%. The infection rateof A.baummanii decreased from19.57%to9.31%.4. The healing rate of A.baummanii pulmonary infection was82.95%. The healingrate of A.baummanii CNS infection was30%. And the CSF sterilization rate was40%. Themortality of A. baummanii CNS infection was70%.Conclusions：1. The NICU A. baummanii infection rate was high, and lung and CNS were the mostcommonly involved sites of infection. A. baummanii had high rate of drug resistance.Except Polymyxin, Imipenem and Cefoperazone-Sulbactam, the rates of A. baummaniiresistance to various kinds of antibiotics were very high.2. Given certain GCS, strengthening nutritional support and early removal of drainagetube may help to reduce the infection rate.3. The application of the infection control system was important method in controllingthe A.baummanii associated nosocomial infection.4. The curative effect of pulmonary A.baummanii infection was better thanA.baummanii CNS infection. Early injection of sensitive antibiotics intraventricularly orintrathecally was an effective way to treat CNS infection caused by A.baummanii.Hydrocephalous occurred in high rate，and drainage should be performed early and keptunobtrusive. Ventricular cistern drainage was prior to lumber cistern drainage...