Risk Factors And Drug Resistance Of Multidrug-resistant Acinetobacter Baumannii Blood Stream Infections In Intensive Care Unit Patients

BackgroundAcinetobacter baumannii(AB)is a common gram-negative bacilli that cause infections in the ICU.With the increase of invasive operations in intensive care units(ICUs)the incidence and mortality of Acinetobacter baumannii bloodstream infections have increased significantly,second only to lower respiratory tract infections.In recent years,due to the widespread use of broad-spectrum antibiotics and the emergence of drug-resistant strains,the increase in drug-resistant bacteria makes treatment of multi-drug resistant Acinetobacter baumannii extremely difficult,especially carbapenem-resistant Acinetobacter baumannii.At present,most of the data on the treatment of resistant strains of this strain comes from retrospective analysis,and the epidemiological characteristics of different countries and regions are different,there are also differences in the sample size and source of the selected group.It is mainly based on the empirical choice of antibiotics to treat multi-drug resistant Acinetobacter baumannii clinically.So this is a very serious problem that humanity faces.This study retrospectively analyzed the risk factors,clinical characteristics and drug resistance of multidrug-resistant Acinetobacter baumannii infection in ICU critical patients in our hospital,and hoped to provide a related clinical data for reducing the incidence of multi-drug resistant Acinetobacter baumannii infection.ObjectiveTo retrospectively analyze the risk factors,clinical features and drug resistance of multi-drug resistant Acinetobacter baumannii infection in critical ICU patients in our hospital,and to provide a clinical basis for reducing the incidence and mortality of multi-drug resistant Acinetobacter baumannii infection.Methods1.Cases source We retrospectively analyzed the patients with multi-drug resistant Acinetobacter baumannii infection in 55 cases of ICU in our hospital from January 2014 to February 2018,and collected possible infection source sites and sites of multi-bacterial infections and bacterial species.Repeated infections in the same part of the same patient were counted for the first time.2.Data collection According to the patient's prognosis during hospitalization,the patients were divided into survival group and death group.The demographic data,basic diseases,source of infection site,invasive operation status,body temperature and blood biochemistry on blood collection day,use of antibiotics,and multidrug resistance,the drug resistance of Acinetobacter baumannii,the APACHEII score and GCS score at the time of ICU admission were collected.3.Statistical analysis SPSS24.0 statistical software was used to process the data.The count data were statistically analyzed using the chi-square test method.The measurement data were statistically analyzed using the rank sum test,and statistically significant variables of rank sum test and chi-square test are included in logistic regression analysis to analyze the clinical characteristics of drug-resistant Acinetobacter baumannii infection,the risk factors that affect the clinical prognosis.P<0.05 was statistically significant,and P<0.01 was statistically significant.Results1.From January 2014 to February 2018,there are 55 cases of multi-drug resistant Acinetobacter baumannii infection in the ICU.Among them,8 patients survived,47 patients died,and the mortality rate was 85.5%.The statistical analysis of basic diseases in the two groups shows that the malignant tumor is P<0.05,and the difference is statistically significant.The APACHEII score at the time of ICU admission and serum creatinine and total bilirubin values of death group are higher than those in the survivor group.The patients in the death group have a longer ICU stay in the pre-infection group than in the survival group,with statistically significant differences(P<0.05).Both hemoglobin and albumin in the death group are lower than those in the survival group(P<0.05),the difference is statistically significant.2.In the survival group,the source of infection site of 4 patients is the lower respiratory tract,3 patients have multiple sites of infection,1 patient have no source of infection site,and 6 patients with multiple bacterial infections.The source of infection site of 26 patients are lower respiratory tract,14 patients have no source of infection site,6 patients have multiple sites of infection,The source of infection site of one patient is thoracic cavity,and 17 patients with multiple bacterial infections.The top 4 bacteria in all patients with multiple bacterial infections are Stenotrophomonas maltophilia,Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa.There is no statistically significant differences in the source of infection site and multiple bacterial infections in the survival and death groups.3.Among the 55 patients,41 patients test for minocycline susceptibility.The results shows that 9(22.0%)patients are sensitive,26(63.4%)patients are intermediates,and 6(14.6%)were resistant.Cefoperazone/sulbactam susceptibility testing was performed in 37 patients,2(5.4%)patients are intermediates,and 35(94.6%)patients are drug resistant.Seven patients are monitored for tigecycline susceptibility,all sensitive(100%);all of patients for imipenem/meropenem,levofloxacin,ciprofloxacin,amikacin,cefoxitin Ceftriaxone,piperacillin,piperacillin/tazobactam,cefepime were all resistant,and the drug resistance rate is 100%.4.The analysis of rank sum test and chi square test showe that there are significant differences between the survival group and the death group in the HB value,serum creatinine value,serum albumin value and total bilirubin value on the day of blood collection.but the independent risk factors related to death are not found when the significant variables are analyzed by logistic regression analysis.Conclusions1.Multidrug-resistance of Acinetobacter baumannii infection in ICU has a high mortality,with a higher APACHEII score at the time of ICU admission,a longer ICU stay before bloodstream infection,and a higher serum creatinine and total bilirubin values,lower hemoglobin values and albumin values on the day of blood collection are risk factors for death.2.The lower respiratory tract is the most common source region of multidrug resistant Acinetobacter baumannii bloodstream infection.3.There is no effective treatment for patients with multidrug-resistant Acinetobacter baumannii bloodstream infection.