Analysis Of Risk Factors And Drug Resistance Of Acinetobacter Baumannii In Intensive Care Unit

Objective:Through the analysis of intensive care unit(ICU) patients with acinetobacter baumannii(AB) infection and distribution,investigate the risk factors of AB infection and drug resistance, provided clues to correct use of antibiotics in clinical and control of nosocomial infectionMethods:363 patients who were hospitalized in Second Hospital of Tianjin Medical University in January 2012 to Decenber as the research object, Collected all hospitalized patients' sputum, blood, urine, tip of alveolar lavage fluid, deep vein tube tip specimens within 24 h, taken to bacteria room for bacterial culture and drug susceptibility test. The cultivation of the AB positived results as the observation group, AB negative results for the control group. By adopting the method of epidemiological studies, according to the review and clinical experiences to determine the statistical analysis of variables. Using SPSS17.0 software for statistical analysis, the hospital information and clinical biochemical indexes in patients with single factor Logistic regression analysis, preliminary screening of AB infection risk factors.Risk factors which have statistically significant difference bring into multiple Logistic regression analysis model. Calculated the relative risk(OR) and 95% confidence interval, P < 0.05 for the difference was statistically significant. Results: Infection rate of AB is in second place in gram-negative bacilli.AB in 363 patients of 51 patients with infection,incidence was 14.08%, multiple drug resistance acinetobacter baumannii(MDRAB) accounted for 39.22%, extensively drug-resistant acinetobacter baumannii(XDRAB) accounted for 37.25%, pan drug resistance acinetobacter baumannii(PDRAB) accounted for 1.96%, sensitive bacteria accounted for 21.57%,in the same period for 312 cases patients who were not infected with AB, accounting for 85.95%..51 cases of AB strains isolated from sputum 36 cases(70.59%), bronchoalveolar lavage fluid 10 cases(19.61%),blood 2 cases(3.92%), deep vein blood tube tip 2 cases(3.92%), urine 1 case(1.96%).Female patients with 23 cases(45.10%), male patients with 28 cases(54.90%). Mixing other bacterial or fungal infection, a total of 29 cases, 6 patients mixed with pneumonic klebsiella infection, 11 patients mixed with staphylococcus aureus infection, 4 cases mixed with pseudomonas aeruginosa infection, 8 patients mixed with fungus infection. 39 patients were used mechanical ventilation, 33 cases were used hormones, 24 cases were received deep vein catheterization, 34 cases with diabetes,37 cases stay in ICU more than 7 days,29 cases were used antibiotics exceed 3 kinds,29 cases albumin less than 25 grams per liter,34 APACHEII scores more than 20 points,45 cases older than the age of 65.After comparing the baseline data and clinical factors found that total protein, blood gas analysis of PH value, average age, duration of ICU stays are obviously higher than that of control group,and albumin, urea nitrogen, glutamic-pyruvic transaminase, glutamic oxalacetic transaminase, partial thromboplastin time are lower than the control group(P < 0.05). The rest of the indicators have no statistical difference(P > 0.05).The single factor analysis results showed that the risk factors of infection caused by AB in ICU were the duration in ICU more than 7 days ?albumin less than 25 grams per liter ?used of invasive mechanical ventilation?deep vein catheterization?used antibiotics exceed 3 kinds?hormonic autacoid?disease of respiratory system?diabetes mellitus?bronchoscope.?older than the age of 65?APACHEII scores more than 20 points(P<0.05). Multiple Logistic regression analysis results showed that the independent risk factors of AB infection were the duration in ICU more than 7 days ?albumin less than 25 grams per liter ?used of invasive mechanical ventilation?deep vein catheterization?used antibiotics exceed 3 kinds?hormonic autacoid?diabetes mellitus?bronchoscope.?older than the age of 65?APACHEII scores more than 20 points(P<0.05).51 strains isolated from the AB with 18 kinds of antimicrobial drug resistance analysis showed that 46 cases of strains resist to ceftriaxone,drug resistant rate was highest,90.2%,4 cases of strains resisted to polymyxin, drug resistant rate was lowest,7.8%. The 15 kinds of commonly used antimicrobial drug resistant rate was more than 70%, high sensitive rate of antimicrobial agents were:Cefperazone-Sulbactam(58.8%)?minocycline(45.1%)?Polymyxin B(92.2%).Through the analysis of prognosis found that the mortality of AB infection group was obviously higher than control group,the mortality of AB infection group was 58.82%,the mortality of control group was 28.85%, the difference was statistically significant.Conclusion: The drug resistance of Acinetobater baumannii were increase gradually year by year,appropriate antibiotic administration?reducing the time of invasive mechanical ventilation ?reducing the invasive operation for patients may take control of Acinetobater baumanii infection.