| ObjectivesThe purpose of this study was to understand the clinical characteristics, assess the risk factors of MDRAB infection and evaluate the predictors of poor outcome in patients with MDRAB infection, accompanied with the drug-resistance change of Acinetobacter baumannii to common antibiotics in recent 3 years.MethodsThe medical records of 291 patients with 316 clinical isolates at the First Affiliated Hospital of Medical University Of Anhui from January 2010 to December 2012 were retrospectively reviewed. Baseline characteristics and potential risk factors were analyzed, including: patient age, sex, admission ward, types of infection, the presence of underlying diseases, duration of hospitalization, ICU stay, surgical procedure, recent invasive procedures, prior exposure to antibiotics, hypoproteinemia, prognosis and et al. Use the traditional methods to cultivate the initial separation strains and analyze its drug resistance to the commonly used antimicrobial agents. Using the non-MDRAB as the control group, the risk factors associated with MDRAB infection were determined. Then, use the non-survivors of the patients with MDRAB infection as the control group to evaluate the predictors related to the poor outcome in patients with MDRAB infection.Results1. For the 291 patients, who consisted of 182 males and 109 females, the mean age was 59.4 +18.0, the mean duration of hospitalization was 33.3+23.9. 226 patients(77.7%) were infected with MDRAB, of whom 80 patients(35.4%) died of this severe infection. Most patients had more than two underlying diseases. Approximately 83.8% patients had undergone the invasive procedures before the Acb was isolated. 274 cases(94.2%) were treated with antibiotics prior to isolation. 2. Of the 316 isolates, 241(76.3%) were multidrug resistant, only 75(23.7%) of the isolates were non-MDRAB. The most frequent infection type was pneumonia(61.7%), followed by bacteremia, skin/soft-tissue infection, urinary tract infection. 3. The risk factors associated with MDRAB infection are:malignant disease(p=0.005), duration of hospitalization(p=0.002),ICU stay(p=0.000),arterial intravascular catheter(p=0.000),mechanical ventilation(p=0.000),third-generation cephalosporins(p=0.003) and carbapenems(p=0.000)。Among them, the independent risk factors are: ICU stay(P=0.000, OR=8.347, 95%CI: 3.138-22.206), prior exposure to third-generation cephalosporins(P=0.007, OR=2.668, 95%CI: 1.312-5.425) and carbapenems(P=0.000, OR=5.109, 95%CI: 2.395-10.900). 4. The risk factors associated with mortality for patients with MDRAB infection are:duration of hospitalization(p=0.000),ICU stay(p=0.002),arterial intravascular catheter(p=0.002) and mechanical ventilation(p=0.000)。Among them, the independent predictors are: duration of hospitalization>30(P=0.000,OR=3.153, 95%CI:1.696-5.864), ICU stay(P=0.036, OR=1.980, 95%CI:1.046-3.751) and mechanical ventilation (P=0.003,OR=2.656, 95%CI: 1.408-5.010). 5. The high rates(>75%) of drug resistance to common antimicrobial agents were observed in recent 3 years at our hospital, especially the imipenem(IPM),which showed a sharp increase from 53.6% in 2010 to 79.0% in 2012. The drug resistance to ceftriaxone(p=0.001), ceftazidime(p=0.002), cefotaxime(p=0.017), gentamicin(p=0.012) present increasingly year after year.ConclusionsMultidrug resistant Acinetobacter baumannii(MDRAB) has emerged as an increasingly important nosocomial pathogen causing a variety of infection over the past few years. Clinical anti-infection treatment has been limited, and the prognosis of the MDRAB-infected patients is poor. Avoiding the risk factors and judicious use of antibiotics are critical for reducing MDRAB infection and the associated unfavorable outcome. |
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