The Analysis Of Prognosis Of Hospital Acquired Pneumonia And The Risk Factors Of Acinetobacter Baumanii Infections

Objective:A retrospective analysis of hospital acquired pneumonia(HAP)caused by Acinetobacter baumannii(AB)and non-AB was conducted at a tertiary teaching hospital to provide reference for the prevention and treatment of HAP,especially AB infection.Methods:All the cases of HAP were collected from 1 January,2014 to 31 December,2015.To identify risk factors associated with AB infection,114 patients with HAP were divided into AB group and non-AB group.To explore the prognosis of HAP and antibiotic treatment outcome,114 cases were divided into survivors and death groups.Patient demographics,clinical and microbiologic date,laboratory examination,underlying diseases,comorbidities and others were retrieved from hospital information system(HIS),antimicrobial treatment were collected,too.The Acute Physiology and Chronic Health Evaluation(APACHE)? score was used to assess illness severity.SPSS20.0 statistical software was adopted for date analysis.For the result,first of relevant variables to single factor analysis,then,will the single factor analysis of meaningful variables,more factors Logistic regression analysis to estimate various risk factors.Results:?.Basic Information1.General information of patientsA total of 114 cases of HAP were collected,including 15 ventilator associated pneumonia(VAP).There were 80 males and 34 females,with an average age of 55.99±19.24years.The first five departments with HAP were ICU(Surgical department),ICU(Internal medicine),Hematology department,Infectious Diseases department and Neurosurgery department.2.Patients received surgical operation,invasive procedures and antibiotic treatment before infections.There were 45 cases of surgical operations before infection(39.5%),There were 31 cases with experience of mechanical ventilation before infection(27.2%),110 cases were treated with antibiotics before HAP(96%).3.Bacteriological examination and drug sensitivity testThe most common isolates were A.baumannii(29),Klebsiella pneumoniae(18)and Pseudomonas aeruginosa(14).The sensitivity rates of A.baumannii to amikacin,tigecycline were 86%and 66%,respectively.?.Analysis of risk factors for A.baumannii infection in HAPThe multivariate analysis showed that admission to ICU(OR=85.588,95%CI 4.408?1661.943;P=0.003),mechanical ventilation(OR=34.502,95%CI 1.024?1161.992;P=0.048),and use of carbapenem within 30 days prior to HAP(OR=12.065,95%CI 2.041?877.223;P=0.015)were the independent risk factorsfor A.baumannii infection in HAP.?.The prognostic factors of HAPThe multivariate analysis showed that the APACHEII score>18(OR=29.520,95%CI 6.268?139.034;P=0.000),ARDS(OR=8.968,95%CI 1.586?50.709;P=0.013),shock(OR=10.046,95%CI 1.275?79.163;P=0.028)were independent risk factors for the death of patients.There was a significant difference in the mortalities with AB-HAP and non-AB-HAP(p=0.047).Conclusions:ICU stay,mechanical ventilation,and use of carbapenem within 30 days prior to infection are the independent risk factors for HAP caused by Acinetobacter baumannii.APACHEII score>18,ARDS,and shock were the independent risk factors for the death of HAP patients.