| Objective: Acinetobacter baumannii(A.baumannii) has emerged as one of the most troublesome pathogens for health care. In order to clarify the risky clinical factors related to multidrug-resistant A.baumannii, we retrospectively investigated the laboratory findings and other clinical factors of NCCU patients suffering from HAP with multidrug-resistant A.baumannii.Methods: A retrospective analysis of traumatic brain injury(TBI) and intracerebral hemorrhage(ICH) patients in NCCU infected with multidrug-resistant A.baumannii from Feb.2010 to Jun.2013 were performed to observe the general epidemiology, diagnosis, Conditions on admission, injury type, severity of injury, antibiotic application, laboratory findings, airway management and outcome correlated with the infection and the recovery of neurological function. Baseline characters such as age, gender and Glasgow Coma Scale(GCS) were collected and other factors like comorbidities were also noted. Outcomes were determined according to GOS scale for neurological function and response to antibiotic therapy was determined using the FDA-defined clinical stability and symptom resolution criteria. Group recovered and non-recovered were for neurological function and group improved and exacerbated were for pneumonia evaluation. We did a prospective treatment of 6 patients with MDR-A.baumannii according to the risk factors discovered.Results: Fifty-eight patients were diagnosed with hospital acquired pneumonia infected with MDR-A.baumannii, the sites of infection were all lower respiratory tract. Of the 58 patients, 17 patients were TBI while 41 patients were ICH, the gender ratio were male: female=35:13. The GCS scale were 20 patients with GCS: 3-7, 25 patients with GCS: 8-12, 13 patients with GCS: 13-15. 9(15.52%) patients were with severe traumatic brain injury. The proportion of tracheotomy, intubation, Ventilator were 55.17%、75.86%、70.69% respectively. The average period of antibiotic usage was 1.81±1.86 days. The average time for antibiotic application was 29.69±14.97 days and kind s of antibiotic used was 2.52±1.66. The most common bacteria before MDR-A.baumannii diagnosis were klebsiella pneumonia and methicillin resistant staphylococcus aureus. After diagnosis, 22 patients were treated withmeropenem and cefoperazone sulbactam sodium, 40 patients with carbopenems. When grouped with GOS scale, 20 patients were classified as non-recovered group and the rest 38 patients were in the recovered group when compared the patients suffering from HAP with MDR- A.baumannii. In univariate analysis, the baseline factors including the blood glucose level(9.02±3.08 vs. 7.49±1.78, P=0.020), the length of NCCU stay(15.18±15.17 vs. 43.30±24.63, P= 0.000), renal insufficiency(5.26% vs. 55%, P=0.000), the number(2.05±1.25 vs. 3.40±1.98, P=0.016) and duration(3.34±1.42 vs. 4.45±2.06, P=0.011) of antibiotics usage were all significantly different between the two groups. The mean level of red blood cells(RBC), platelet count(PLT), total blood protein(TBP) and serum albumin(ALB) before and after infection also had significant statistical difference. Multivariable logistic regression analysis identified that the length of NCCU stay, the mean level of PLT after infection and ALB before infection were independent risk factors. And when compared with the outcome of infection in 30 days, 28 patients were improved while 30 patients were exacerbated. The level of plate count after infection had significant statistical difference. And when compared in 60 days, 38 patients were improved while 20 patients were exacerbated. The level of plate count and white blood cell after infection, NCCU stay, renal impairment had significant statistical difference. Multivariable logistic regression analysis identified that the length of NCCU stay, renal impairment were independent risk factors. The prospective treatment of 6 patients with MDR- A.baumannii conducted subsequently. The patients were treated with enough nutrition supply, their albumin, plate count maintained to the normal level, and when the conditions were better, the patients were transferred to the common ward. They all got an expected outcome with condition of infection improved and neurological function recovered.Conclusions: The factors predisposing to the risk of patients infected with MDRA.baumannii included severity of injury, invasive airway management, prolonged use and frequent switch of antibiotics; maintaining the basic nutrition was probably the mainly factor to promote the improvement of the disease. The length of NCCU stay, the mean level of PLT after infection and ALB before infection were independent risk factors for the neurological functional outcome of NCCU patients withmultidrug-resistant A.baumannii. But as for infection, the mean level of PLT after infection was found to be a risk factor among these patients. It was helpful for patients with MDR- A.baumannii supplying with enough nutrition, maintaining the mean level of plate count, albumin and shorten the length of NCCU stay. |
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