| Objective: In recent years,bacterial resistance has become the focus of global attention.Globally,"ESCAPE" resistance has become an important cause of morbidity and mortality.Among the bacterial resistant types,carbapenem-resistant acinetobacter baumannii(CRAB)poses a particularly solemn problem.Up to now,the domestic studies on the drug resistance of acinetobacter baumannii are mostly from large-scale tertiary hospitals,which cannot fully reflect and represent the status of drug resistance in county secondary hospitals.Therefore,the purpose of this study is to understand the resistance of acinetobacter baumannii to commonly used antimicrobial agents in secondary comprehensive hospitals of Sichuan province,and to analyze the clinical characteristics and related risk factors of the infections caused by carbapenem-resistant acinetobacter baumannii in secondary comprehensive hospitals.Methods: 1.In this study,a retrospective case-control study design was performed,and Acinetobacter baumannii infection patients in 6 comprehensive hospitals of Class II Grade A(including the Second People's Hospital of Ya'an City,the People's Hospital of Pingwu County,the People's Hospital of Xindu District,the People's Hospital of Nanbu County,the People's Hospital of Lezhi County,and the First People's Hospital of Jintang County)in Sichuan province from January 2015 to January 2016 was investigated.A survey form was designed according to the actual status of the second-level comprehensive hospitals.The following indicators were included in the form: general condition,complications,the status in ICU,length of hospitalization,invasive operations and the use of antibiotics.2.The sensitivity of Acinetobacter baumannii to commonly used antimicrobial drugs was determined by the Minimum inhibitory concentration method(MIC),and the drug resistance of Carbapenem-resistant acinetobacter baumannii and carbapenem-sensitive Acinetobacter baumannii in 6 second-level comprehensive hospitalswas analyzed.3.All strains were divided into the carbapenem-resistant Acinetobacter baumannii group(research group,CRAB)and the carbapenem-sensitive Acinetobacter baumannii group(control group,CSAB)on the basis of the results of drug sensitivity test.The hospital records of the infected patients were investigated and the data were collected in the two groups for case-control study.SPSS20.0 software was used for data collection and analysis.Firstly,an univariate analysis was conducted,using x ±s to demonstrate measurement data.The comparisons of mean conforming to normal distribution were tested in independent sample t-test while the non-normal distributed data were tested in non-parametric test.The data were demonstrated with case number and x2 test was adopted in the between-group design with P<0.05 to ensure the judgment criteria for difference was statistically significant.According to the results of single factor analysis,those statistically significant variables were selected for multivariate logistic regression.The 95% confidence intervals(95% CI)and odds ratio(OR)were calculated.P<0.05 was considered statistically significant.Results:(1)A total of 202 strains of acinetobacter baumannii were collected,with 90 strains of carbapenem-resistant Acinetobacter baumannii and 112 strains of carbapenem-sensitive to acinetobacter baumannii.Among the 90 patients with infections caused by carbapenem-resistant acinetobacter baumannii,22 were females,accounting for 24.4%,with an average age of 66.5±15 years,and an average length of hospitalization of 15.6±11 days.Among 112 patients with infections caused by carbapenems-sensitive acinetobacter baumannii,41 were females,accounting for 36.6%,with an average age of 68.4±13 years,and an average length of hospitalization of 9.2±7 days.The isolated acinetobacter baumannii mainly came from the intensive care unit(ICU)and respiratory medicine department,accounting for 41.1% and 19.8%,respectively.The main source of specimens was sputum,accounting for 89.60%,followed by wound secretion.2.The resistance rate of Acinetobacter baumannii to carbapenem was 40.1%.Carbapenem-resistant Acinetobacter baumannii was also resistant to many common clinical antimicrobial agents.The drug resistance rates ranged from low to high: levofloxacin(88.9%),amikacin(89%),cefpime(95.6%),ciprofloxacin(95.6%),cefotaxime(98.7%),piperacillin(98.7%),ceftazidine(98.9%),gentamicin(98.9%),piperazolobatam(100%);Carbendene-sensitive Acetobacter baumannii is sensitive to most antimicrobial drugs,with the highest resistance rate for cefotaxime(25%),followed by piperacillin(14.1%).The resistance rate for the remaining antimicrobial drugs was less than 10%.3.According to univariate analysis,the risk factors causing carbapenem-resistant acinetobacter baumannii include: hepatic insufficiency,hypoproteinemia,length of hospitalization,ICU stay,30-plus days of hospital stay,invasive procedure(central venous catheter,urinary catheterization,gastric tube intubation,surgical drainage,elective/emergency operation),mechanical ventilation,use of fluoroquinolone and carbapenem,and the long time use of antibiotics.Through multivariate analysis,4 independent risk factors of the infections caused by carbapenem-resistant acinetobacter baumannii were singled out: urinary catheterization(OR=9.576,95% CI=4.964-18.474;P=0.000),central venous catheterization(OR=2.707,95% CI=1.158-6.330;P=0.022),the use of fluoroquinolone(OR=3.869,95% CI=1.603-9.377;P=0.003),and the application of carbapenem antibiotics(OR=2.755,95% CI=1.164-6.521;P=0.021).Conclusion:1.The infection of Acinetobacter baumannii mostly occurs in ICU and respiratory medicine department.The clinical isolates mainly come from sputum.The infection caused by Acinetobacter baumannii in second-level comprehensive hospitals is still mainly respiratory infection.2.The drug resistance of Acinetobacter baumannii in the second-level comprehensive hospitals of Sichuan Province was not optimistic,and its resistance to carbapenems antibiotics is serious,and carbapenem-resistant acinetobacter baumanniiis mostly multi-drug resistant bacteria.3.According to univariate analysis,the risk factors of the infections caused by carbapenem-resistant acinetobacter baumannii are hepatic insufficiency,hypoproteinemia,length of hospitalization,ICU stay,30-plus days of hospital stay,invasive procedure(urinary catheterization,central venous catheter,surgical drainage,gastric tube intubation,elective/emergency operation),mechanical ventilation,use of fluoroquinolones and carbapenems,and the long time use of antibiotics,among which urinary catheterization,central venous catheter,use of fluoroquinolone antibiotics and carbapenem antibiotics are the independent risk factors for the occurrence of carbapenem resistance in acinetobacter baumannii. |
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