Clinical Characteristics Of Patients With Acinetobacter Baumannii In ICU And Analysis Of Risk Factors For Death

Objective:The purpose of this study is to provide an effective measure for the prevention and control of Acinetobacter baumannii infection by analyzing the epidemiological characteristics,drug resistance and risk factors of Acinetobacter baumannii infection in ICU wards.Methods:1.The clinical data,laboratory tests and drug susceptibility results of 173 patients with Acinetobacter baumannii infection in ICU wards from January 2016 to December 2017 were collected.Based on the Diagnostic Criteria for Hospital Infections,remove colonized bacteria and patients who are not infected in the hospital,the remaining 80 patients who was nosocomial infections and sicked.According to drug susceptibility results,these 80 patients were divided into multi-drug resistant group and non-resistant group.And according to the survival of patients within 30 days after diagnosis,they were divided into the diseased group and the survival group.Finally,the independent risk factors for the death of Acinetobacter baumannii in ICU wards were analyzed by mean ± standard deviation,independent sample t test,chi-square test and multivariate logistic regression model.2.Cotton swab smears were used to collect samples from the surface of ICU environmental objects such as bedside tables,bed rails,consoles,ventilators,monitors,infusion sets,etc,and the hand of the medical staff.The bacteria on the surface of these samples were isolated,cultured and identified.Results:1.There were 80 patients with Acinetobacter baumannii in the ICU ward,of which 68 were infected with multidrug-resistant Acinetobacter baumannii and 12 were infected with non-multidrug-resistant Acinetobacter baumannii.2.Among the 80 patients with Acinetobacter baumannii infection in ICU ward,the most isolated AB was found in respiratory secretions,accounting for 74.7%.The detection rates of wound secretion,blood,urine,and tissue fluid were 12.1%,10.1%,2.0%,and 1.0%,respectively.It can be seen that the infection of AB in ICU patients is mainly caused by respiratory infection,followed by wound secretion and drainage fluid,blood,urine and tissue fluid.3.The same cloned strain often can be detected on the surface of environmental objects such as bedside tables,bed rails,consoles,ventilators,monitors,infusion sets and so on and in the hands of medical staff.This is the main cause of AB cross infection in ICU wards.4.The resistance rate of patients infected with multidrug-resistant Acinetobacter baumannii in ICU wards to tobramycin,ciprofloxacin,piperacillin/tazobactam,piperacillin,acarbamicin,ticarcillin/clavulanic acid was 100%;resistance to carbapenem antibiotics was up to 98.6%;resistance to cefoperazone/sulbactam was 82.4%;mediation or sensitivity to minocycline.There are 2 patients with all drug resistance.5.The risk factors for death in patients infected with Acinetobacter baumannii in ICU wards may include age?80 years(P=0.024),severe trauma(P=0.009),multi-drug resistance(P=0.036),hypoproteinemia(P=0.016),shock(P=0.014)and endotracheal intubation or tracheotomy(P=0.024),among them,hypoproteinemia(P=0.039,OR=20.456,95%CI=1.162-367.224),shock(P=0.026,OR=4.320,95%CI=1.194-15.627),age?80 years(P=0.016,OR=16.391,95%CI=1.696-158.414)are independent risk factors for death of patients with Acinetobacter baumannii infection in ICU wards of our hospital.Conclusions:1.The infection site of Acinetobacter baumannii in the ICU patients is mostly located in the respiratory system,followed by the blood system,wounds and urinary system.2.The same cloned strain often can be detected on the surface of the surroundingenvironmental objects and in the hands of medical staff in the ICU ward,which is the main cause of AB cross infection in the ICU ward.3.Patients with MDRAB infection in the ICU ward of our hospital were intervening or sensitive to minocycline;the resistance rate to cefoperazone/sulbactam was slightly higher;and the fully resistant strain was isolated.4.The risk factors for death in patients with Acinetobacter baumannii in the ICU ward of our hospital may include age ? 80 years,severe trauma,multidrug resistance,hypoproteinemia,shock and endotracheal intubation or tracheotomy,of which low protein blood Symptoms,shock,age ? 80 years old are independent risk factors for death in patients with Acinetobacter baumannii infection in the ICU ward of our hospital.