| Objective: Pneumonia is the inflammation of terminal bronchioles,alveolar and interstitial of the lungs,and it is a clinical common disease and frequently occurring disease.The severe pneumonia is a common critical illness in respiratory department of internal medicine,often involving multiple organs dysfunction,rapid progression and poor prognosis.Although with the continuous improvement of medical technology,the severe pneumonia mortality rate remains high.Acinetobacter baumannii is one of the most important pathogens of nosocomial infection in our country,and the main planting site is respiratory tract.In recent years,the drug resistance of acinetobacter baumannii to antibiotic is on the rise.The clinical treatment is difficult and the mortality rate of infection was higher than before.The aim of this study is to analyze the clinical features of patients with severe pneumonia infected by multiple drug resistant acinetobacter baumannii,and to explore the risk factors associated with the prognosis.The disease condition and prognosis can be given effective assessment and prediction.And this study may provide reference and basis for clinical treatment of such patients.Methods:1 Select a total of 60 patients with severe pneumonia caused by multiple drug resistant acinetobacter baumannii in intensive care unit of respiratory department of internal medicine,Second Hospital of Hebei Medical University from March 2015 to October 2015.The selected cases meet the guidelines for the diagnosis and treatment of adult community acquired pneumonia in China in 2016.The selected cases meet the diagnostic criteria of the Chinese acinetobacter baumannii infection diagnosis and prevention expert consensus published by Chen Baiyi etc.in 2012.2 The clinical data of 60 patients were retrospectively analyzed,including general conditions: age,gender,height and weight,consciousness,vital signs,smoking and drinking history,etc.;basic diseases: including chronic obstructive pulmonary disease,bronchial asthma and other pulmonary diseases,cerebral hemorrhage,cerebral infarction,hypertension and coronary heart disease and other cardiovascular and cerebrovascular diseases,diabetes,cancer,etc.;recent history of the hormone and immune inhibitor application;laboratory data,including procalcitonin(PCT),blood routine,liver function,renal function,electrolyte,myocardial enzymes,arterial blood gas analysis and pathogenic examination(urine culture and sputum culture and blood culture);ICU hospitalization time;the ventilation way,including oxygen,noninvasive ventilation,endotracheal intubation,tracheotomy;antibiotic therapy;Acute Physiology and Chronic Health Evaluation;total intake of 24 hours(including intravenous fluids and gastrointestina nutrition)and total output(including urine,feces,vomit,exudates,and drainage)in 72 hours;Outcome: improvement and death.3 According to the patient's prognosis,the patients were divided into survival group and death group.We compared the clinical characteristics of the two groups by single factor analysis and logistic regression analysis.If the clinical data is the measurement data,it should be expressed by the mean ± standard deviation and analyzed by t test or analysis of variance test.If the case data is count data,it should be analyzed by chi square test.Results:1 The clinical data of 60 patients were retrospectively analyzed,including 39 cases of male,21 cases of female,at average age of 73.5±9.5 years old,31 cases of survival group(51.7%),29 cases of death group(48.3%),and the mortality rate of the study was 48.3%.There were 127 strains of acinetobacter baumannii,including 98 multidrug resistant acinetobacter baumannii strains(77.2%)and 29 non multidrug resistant acinetobacter baumannii strains(22.8%).26 patients were given mechanical ventilation(43.3%),and 34 patients received mechanical ventilation(56.7%).There were 60 cases(100%)patients treated with carbapenem antibiotics meropenement,27 cases(45%)treated with cefoperazone sodium and sulbactam sodium,11 cases(18.3%)treated with tigecycline.2 The clinical data of the survival group and death group of patients were retrospectively analyzed,it was found that the average age of the two groups were(69.97±9.92)and(77.38±7.56),t=-3.267,P=0.002;The APACHE II scores of the two groups were significantly higher,and the APACHE II scores of the death group was higher than that of the survival group,(21±3.72)and(23.41±3.99)respectively.t=-2.416,P=0.019.The time in hospital of death group was shorter than that of the survival group,respectively(17.62 ±11.08)and(28.45±14.31),t=3.289,P=0.002;The PCT of the death group was higher than that of the survival group(6.14±8.33)and(1.28±1.37),t=-3.202,P=0.002;The mortality rate of negative balance and positive balance of fluid accumulation in 72 hours were 30% and 66.7% respectively,?2=8.076,P=0.004.The mortality rates of mechanical ventilation and non mechanical ventilation were 67.6% and 23.1%,?2=11.72,P=0.001;Univariate analysis suggested that age,APACHE II score,PCT,positive balance of fluid accumulation in 72 hours balance and mechanical ventilation may be associated with prognosis of the patients with pneumonia caused by multiple drug resistant acinetobacter baumannii.The white blood cell count,C reaction protein,whether patients combined with lung diseases,cerebrovascular disease,diabetes mellitus may not be associated with the prognosis(P>0.05).3 Logistic regression analysis showed that higher serum level of PCT,the need for mechanical ventilation and positive balance of fluid accumulation in 72 hours may be the independent risk factors for the poor prognosis of the patients with pneumonia caused by multiple drug resistant acinetobacter baumannii.Conclusion:1 Analysis of the patients with severe pneumonia caused by multiple drug resistant acinetobacter baumannii showed that the death group of patients had characteristics with older age,higher APACHE II score,higher PCT and positive balance of fluid accumulation in 72 hours and the need for mechanical ventilation.2 Logistic regression analysis found that higher serum procalcitonin and need for mechanical ventilation and positive balance of fluid accumulation in 72 hours were the prognostic risk factors of the patients with severe pneumonia caused by multiple drug resistant acinetobacter baumannii. |
PDF Full Text Request