The Clinical Research Of Acinetobacter Baumannii Infection On Perioperative's Infants

Objective To study the risk factors and drug resistance rates caused by Acinetobacer baumannii(Ab).To guide the clinician how to suitable use of antibiotics and reduce the nosocomial infection of Ab on perioperative's infant.Methods Clinical data of 100 infants' patients who were diagnosed as Ab infection and 200 infants patients as control group.To divide Ab infection into 62 infants' patients who were treated on mechanical ventilation and 38 infants' patients who weren't treated on mechanical ventilation.They all treated on perioperative in PICU of Xinhua Hospital Affiliated to Shanghai Jiaotong School of medicine from Jan1,2011 to Dec 31,2015 in PICU were retrosepectively analyzed.The risk factors of Ab infection were obtained by using univariate and multivariate stepwise Logistic regression analysis.Results Among the 100 infant's patients were indentified to Ab infection including 66 males and 34 females.Among the 200 infant's patient were indentified to control including 131 males and 69 females.Two group age ranged from neonatal to36months(median age: 3.1months and 3.5moths).Between Ab group and control group: the average total hospital stay [(21.0-62.0)days],the average ICU stay[(9.0-34.5)days],the time for mechanical ventilation [(0.0-9.0)days ],open surgery(88.0%),preoperative broad-spectrum antibiotics use(76%),preoperative nutrition status: severe and median malnutrition(17% and 17%),central venous catheter(62%),chest tube(37%),and external ventricular drainage tube(5%),were much higher in Ab group than those in control group[(11.0-18.0)days,(2.0-6.0)days,(0.0-0.0)days,70.5%,31.5%,(6.5% and 8%),29%,1.5%,0.5%,respectively,all P<0.05].The average weight of ICU [(3.0-8.5)kg] was much lower in Ab group than this in control group [(4.0-8.0)kg],P <0.05.Logistic regression analysis showed that the average weight of ICU(OR=1.000)maybe the independent risk factor associated with Ab infection.Between the MV group and n-MV group: the average of total hospital stay [(27.7-67.2)days],the average ICU stay [(14.7-52.7)days],preoperative nutrition status: severe and median malnutrition(21.0% and 21.0%),central venous catheter(77.4%),and chest tube(29%),were much higher in MV group than those in n-MV group [(19.7-51.5)days,(4-17.5)days,(10.5% and 10.5%),36.8%,21.1%,respectively,all P <0.05].The average weight of ICU [(2.8-6.1)kg],the average age[(0.0-6.8)months],and gestational week more than 37weeks(75.8%),were much lower in MV group than those in n-MV group [(4.2-12.0)kg,(1.3-15)moths,(97.4%),respectively,all P <0.05].Logistic regression analysis showed that the average ICU stay(OR=1.124)and central venous catheter(OR=6.456)were the independent risk factors associated with mechanical ventilation in Ab infection.There were 50% Ab from respiratory tract,20% from pleural effusion and 8% from blood culture.Comparison of nearly 2 years and past 3 years,the drug resistance was significantly increased.The percentages of Carbapenems antimicrobial increased from 74% to 90%,cephalosporin antibiotics increased from 76% to 92%,cefoperazone/ Sulbactam from36% to 52%.Nearly two years only Sulfamethoxazole,minocycline resistant rates were less than 50%.Conclusion In recent years,Ab resistance rates are obviously increased,we should early recognition of the high risk factors for Ab infection,rational use of antibiotics,to minimize invasive procedures,strengthen nutrition and improvement of microbiological monitoring.