Study On Current Status Of Acinetobacter Baumannii Infection Among RICU Patients Of Atertiary Hospital And Countermeasures

BackgroundAcinetobacter baumannii, which belongs to non-fermenting sugars gram-negative bacteria, are widely distributed in nature environment, human skin and hospital environment. Acinetobacter baumannii have a long-term survival in the natural environment and the body surface, which belongs to opportunistic pathogens and shows high clonal propagation pathogens and acquired drug resistance. Extensively drug resistant Acinetobacter baumannii, multi-drug resistant Acinetobacter baumannii and pan-resistant Acinetobacter baumannii have shown global prevalence trends.The acinetobacter baumannii caused hospital-acquired pneumonia, intra-abdominal infections, urinary tract infections, bloodstream infections, skin and soft tissue infections, central nervous system infections have become one of the important pathogens of nosocomial infections. The 2010 Chinese CHINET bacterial resistance monitoring network provided that 16.11% of the clinical gram-negative bacteria are acinetobacter baumannii,behind Escherichia coli and Klebsiella pneumoniae.The data came from 14 teaching hospitals in 10 provinces of China.The main risk factors of acinetobacter baumannii infection include long hospital stay, antimicrobial drug exposure, mechanical ventilation, invasive procedures, ICU stay and serious underlying disease. Once infected by acinetobacter baumannii,the length of patient stay would be extended, while the cost of hospitalization would be increased,and acinetobacter baumannii even lead to patient mortality. So acinetobacter baumannii infection has drawn the high attention of medical staff.ObjectiveBased on the microbiological culture results and clinical diagnosis and treatment data from the RICU patients in a level 3 general hospital, the aims of this study were to assess the situation and drug resistance of Acinetobacter baumannii infections in the hospital, and to compare the impacts of gender, age, underlying disease, APACHE II score, invasive procedures and other factors on Acinetobacter baumannii infection rates. Besides, we aimed to find the Acinetobacter baumannii infection risk factors and the corresponding OR value by multivariate Logistic regression analysis, and then to explore the prevention and isolation precautions of Acinetobacter baumannii infection.Materials and methodsThis study was a retrospective analysis of 264 patients from 2010 to 2011 who stayed in the Respiratory Medicine Care Unit (RICU) of a level 3 general hospital. Through the hospital’s case inquiry system, the clinical data of these patients were collected, including various types of microbial laboratory specimen test results, demographic data, acute physiology and chronic health evaluation II (APACHE II) score, combined underlying diseases, invasive procedures, drug use, bacterial resistance, prognosis and so on. We aimed to assess the infection rate and drug resistance situation of Acinetobacter baumannii in the RICU ward by collating information and statistical analysis and to analyze the mixed infection situation of the patients infected by Acinetobacter baumannii. Besides, we aimed to compare the impacts of gender, age, underlying disease, APACHE II score, invasive procedures and other factors on Acinetobacter baumannii infection rates. Besides, we aimed to find the Acinetobacter baumannii infection risk factors and the corresponding OR value by multivariate Logistic regression analysis, and then to explore the prevention and isolation precautions of Acinetobacter baumannii infection. Statistical methods: the measurement data were compared using the t test (normal distribution) or rank sum test (non-normal distribution), while the count data were compared using chi-square test. Multivariate logistic regression analysis was used to analyze the classification, and the corresponding OR value and 95% confidence intervals were found, then Wald test hypothesis testing was used for regression coefficients, p< 0.05 was considered statistically significant.Main ResultsWe collected 264 RICU patients, including 160 men and 104 women, aged between 33 and 92 years old, the average 67.3 years. The total infection rate was 27.65%, among which the infection rate for male and female RICU patients were 28.75% and 25.96% respectively.Correlation analysis result showed that there was a significant positive correlation between the infection rate among RICU patients and APACHE Ⅱ score.Coefficient of association r= 0.9632.By Logistic regression analysis, the independent risk factors of Acinetobacter baumannii infections in RICU patients were invasive procedures (OR=4.257), fungal infections (OR=3.782), APACHE Ⅱ score (OR=2.532), combined with underlying diseases (OR=2.104), advanced age (OR=1.812).Conclusions1. The Acinetobacter baumannii infection rate of the RICU patients in the hospital was very high, and the resistant situation is very grim.2. The independent risk factors of RICU patients with Acinetobacter baumannii infection include invasive procedures, mechanical ventilation, APACHE Ⅱ score, combined with underlying diseases, old age.3.The effective measures to prevent and control Acinetobacter baumannii infection include strict compliance with aseptic technique and infection control practices, enhanced emphasis on high-risk patients, raised awareness for hospital infection and APACHE Ⅱ score of health workers, strengthened clinical management of antibiotics.