| Objective:To analyse the clinical characteristics,resistance changes,antimi-crobial therapy and risk factors of poor prognosis of patients with Acinetobacter Baumannii(AB)bloodstream infection in the hospital,to imProve clinicians,awareness and attention to AB bloodstream infection,and to improve clinical prognosis.Methods:A retrospective analysis of AB blood culture-positive patients in the bacterial chamber database from January 2010 to September 2018 was carried out,clinical data were recorded in detail.To analyze the clinical characteristies and the drug resistance tendency of patients with AB bloodstream infection.According to the prognosis,it is divided into two groups of good prognosis(88 cases)and poor prognosis(113 cases),and the risk factors of poor prognosis were analyzed in Patients with AB bloodstream infection with single factor and logistics multi-factor regression.Result:1.CD A total of 201 cases of AB bloodstream infection were collected,136 cases of men(67.7%),with an average age of 52.52±17.83 years old.?The distribution of departments is dominated by ICU,aeeounting for 22.9%.?The most common basic diseases are hypertension 17cases(23.4%),diabetes 29 cases(14.4%),cerebrovascular disease 25 cases(12.4%),solid tumors 21 cases(10.4%),coronary heart disease 20 cases(10.0%),COPD 18 cases(9.0%),etc.2.?AB bloodstream infection patients on the day of sampling 183 cases(91.0%)of different degrees of fever,including low fever 19 cases(10.4%),moderate fever 90 cases(49.2%),high fever 69 cases(37.7%),ultra-high fever 5 cases(2.7%).?on the day of sampling APACHE ? score 15(8-11),the time spent in hospital before infection AB was 11(5-18).? There were 103 patients(51.2%)with white blood cell count greater than 10×10g/L on the day of sampling and 19 patients(9.5%)with white blood cell count less than 4×109/L.There were 170 patients(84.6%)with a percentage of neutrophils greater than 75%The median values of serum albumin and serum creatinine were[28.2(24.4-31.7)]g/L and[71.6(50.0-99.0)]mol/L.PCT was measured in 83 patients on the day of sampling,among which 54(65.0%)were patients whose PCT was greater than 0.5ng/mL?Invasive procedures were performed in 154 patients(75.8%)before AB infection,and antibiotics were administered in 191 patients(95.0%)3.? Univariate analysis revealed that risk factors for poor prognosis of AB bloodstream infection were older than 65 years,older than 65 years,and basic diseases before infection is greater than or equal to three,a total length of hospital stay more than 7 days,serum albumin,serum creatinine values on admission,infection of ICU admission,AB types of antimicrobial drug use is greater than or equal to three,carbapenems were used as antibiotics,hormone use time more than 7 days,tracheal intubation or tracheostomy,jejunum nutrition tube/stomach tube,and placing a urinary catheter indwelling central venous catheter,long tube insertion/temporary hemodialysis,infection before using acid inhibitors,parenteral nutrition,sampling the APCAHE ? score greater than or equal to 18.5 points,sampling from the white blood cells is less than 4×109/L,neutrophils Ratio,serum albumin,serum creatinine value,serum creatinine value and multiple drug resistance(P<0.05).?Logistics multi-factor regression analysis showed that independent risk factors for poor prognosis of AB bloodstream infection were the time of use of hormone use time more than 7 days,the retention center of intravenous catheterization,sampling the APCAHE ? score greater than or equal to 18.5 points,multi-drug resistance(P<0.05)4.?AB with the lowest resistance rate(17.9%)is tigecycline in the isolated cases of this study,followed by minocycline(25.0%).cefoperazone-sulbactam(40.6%),and levofloxacin(48.7%),further analysis found that,the drug resistance rate of amikacin,minocycline,tobramycin and tigecycline showed an increasing trend year by year(P<0.05).?The isolation rate of multiple drug-resistant strains in the prognosis group was significantly higher than that of the prognostic group[105(93.0%)vs.56(63.6%),P<0.05]5.Multidrug-resistant AB bloodstream infection patients with a treatment based on cefoperazone-sulbactam have a good prognosis(P<0.05)Conclusion:1.Patients with AB bloodstream infection tend to be older and have more basic diseases,and the departments are mainly distributed in ICU,which can also be seen in the department of burn and plastic surgery,emergency department and respiratory and critieal hospital available et al.In addition,the drug resistance rate of AB bloodstream infection patients was high,and the rate of poor prognosis was 56.2%,with poor prognosis2.The independent risk factors of poor prognosis were AB bloodstream infection were the time of use of hormone use time more than 7 days,the retention center of intravenous catheterization,sampling the APCAHE ? score greater than or equal to 18.5 points,multi-drug resistance(P<0.05)3.Treatment regimens based on cefoperazone-sulbactam can improve the prognosis of patients with multidrug-resistant acinetobacter baumannii blood-stream infection. |
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