Analysis Of Risk Factors And Drug Resistance For Hospital-acquired Pneumonia Caused By Imipenem-resistant Acinetobacter Baumannii

Background and Objective:Acinetobacter baumannii is widespread in nature、the hospital environment and human skin、respiratory、gastrointestinal and urogenital tract, is one of the most common causes caused by a serious hospital-acquired infections, such as ventilator-associated pneumonia, bacteremia and meningitis, with high morbidity and mortality. In recent years, the situation of drug-resistant Acinetobacter baumannii is gradually grim, multi-drug resistant、extensively drug-resistant and pan drug-resistant strains continue to emerge. Carbapenem antibiotic was considered to be one of the most effective drugs to treatment infected with Acinetobacter baumannii, but in recent years, carbapenem-resistant Acinetobacter baumannii increased year by year, CHINET monitoring shows that Acinetobacter baumannii sensitive to imipenem was60.6%in2007, but decreased to34.3%in2010, and once it resistance to carbapenem antibiotic, then for other antibiotics are basically resistant, clinical treatment brought great difficulties. To understand the carbapenem-resistant Acinetobacter baumannii resistant status quo, analysis of drug resistance for imipenem-resistant Acinetobacter baumannii (IRAB) in First Affiliated Hospital of Zhejiang University, and to study risk factors for imipenem-resistant Acinetobacter baumannii hospital-acquired pneumonia, designed to provide evidence for prevention and treatment imipenem-resistant Acinetobacter baumannii hospital-acquired pneumonia.Methods:Retrospective analysis of clinical data from January2011to December2012where201cases of Acinetobacter baumannii in patients with hospital-acquired pneumonia in our hospital, where the IRAB group consisted of155cases and the imipenem-sensitive Acinetobacter baumannii (ISAB) group consisted of46cases, to take the univariate analysis and multivariate logistic regression analysis between the two groups, analyze risk factors of imipenem-resistant Acinetobacter baumannii hospital-acquired pneumonia, and analyze resistance to16kinds of antimicrobial agents of IRAB, and30-day mortality of the two groups were recorded.Results:Univariate analysis showed that:ICU stay, coma, endotracheal intubation/cut, mechanical ventilation, indwelling stomach tube, the duration of glucocorticoid use≥7days,2and more antibiotics combination, previous used the carbapenem antibiotic within28days before isolation of AB, APACHE II score on admission≥20were significantly associated with IRAB HAP, Multivariate Logistic regression analysis showed that previous used the carbapenem antibiotic within28days before isolation of AB and APACHE Ⅱ score on admission≥20were independent risk factors for IRAB HAP; The resistant rate to amikacin is lower of IRAB (38.7%), cefoperazone sulbactam rate up to64.5%, and contrast ISAB, most of the antimicrobial drug resistance rates increased significantly in IRAB, the IRAB group of patients with marked increase in mortality.Conclusion:Previous used the carbapenem antibiotic within28days before isolation of AB and APACHE II score on admission≥20were independent risk factors for IRAB HAP, drug resistance of IRAB was extremely serious, all of IRAB were multi-drug resistant strains, IRAB HAP patients with poor prognosis and high mortality.