| Objective Assessing the risk factors of Carbapenem-resistant Acinetobacter baumannii（CRAB）and Multidrug-resistant Acinetobacter baumannii（MDRAB）pulmonary infection is to provide reference and basis for clinical prevention and control of infection.With the increasingly prominent problem of aging in our country,It is very important to master the susceptibility factors of pulmonary infection of Acinetobacter baumannii（AB）in elderly patients and to reduce the infection rate,drug resistance rate and mortality of Acinetobacter baumannii from the source.Methods1 A clinical study on risk factors of carbapene-resistant Acinetobacter baumannii was conducted in CNKI,Wanfang,VIP,Pub Med,Embase,Cochrane,Web of Science,and Chinese biomedical literature database.The retrieval time is from the data library building to May 2021.Meta-analysis used Stata16.0 software.2 A case-control study was used in the clinical experiment.A total of 200 elderly hospitalized patients（≥80 years old）with pulmonary infection of Acinetobacter baumannii from the hospital from January 2017 to December 2019 were collected.According to sputum culture results,200 patients were divided into multiple drug-resistant acinetobacter baumannii group（MDRAB group）and non-multiple drug-resistant acinetobacter baumannii group（non-MDRAB group）,and general clinical data of the above subjects were collected.Among them,93 cases in MDRAB group were used as observation group,and 107 cases in non-MDRAB group were used as control group.The MDRAB group was split in two in the light of the final result of infection-the survival group including 58 cases and the death group and including 35 cases.I analyzed the data with SPSS20.0 software.Measurement data were expressed as± S or M（Q25,Q75）.T test or Mann Whitney U test were used for comparison between groups.When p < 0.05,we think the difference is significant.Then the meaningful variables in univariate analysis were analyzed by logistic regression.Compared with the above methods,The survival group and the death group was analyzed to explore the prognostic factors of infected patients.Results1 A total of 10 studies were included in the meta-analysis,including 32 risk factors,13 of which were statistically significant,including age（MD = 0.147,95%CI:0.002-0.291）,APACHE Ⅱ score at admission（MD = 1.029,95%CI: 0.699-1.359）,ICU admission（OR = 9.612,95% CI: 2.606-35.462）,hypoproteinemia（OR = 5.372,95% CI: 3.157-9.142）,mechanical ventilation（OR = 6.524,95% CI: 3.452-12.332）,mechanical ventilation time（MD = 0.600,95%CI: 0.225-0.975）,endotracheal intubation/incision（OR = 4.233,95%CI: 2.087-8.587）,indentation gastric tube（OR =2.408,95%CI: 1.141-5.081）,combined use of antibiotics（OR = 5.917,95%CI:2.646-13.234）,and use of carbopenicase before infection（OR = 7.641,95%CI: 4.799-12.167）,quinolones used before infection（OR = 1.541,95%CI:1.038-2.286）,aminoglycosides used before infection（OR = 0.673,95%CI: 0.465-0.973）with other bacterial infections（OR = 2.018,95%CI: 1.115-3.651）.2 Univariate analysis of the MDRAB and non-MDRAB groups found that: There were statistical significance in patients with urinary tract infection,severe pneumonia,long-term bed rest,albumin,invasive operations（such as gastric tube placement,catheterization,endotracheal intubation/incision,deep vein catheterization and various drainage tubes）,duration of antibiotic use and APACHE Ⅱ score ≥20 points at infection time（p<0.05）.There were no statistically significant differences in gender,smoking history,hypertension,diabetes,chronic obstructive pulmonary disease,cardiac insufficiency,liver and kidney insufficiency,thrombocytopenia and antibiotic combination（p>0.05）.Significant factors were included in Logistic multivariate regression analysis showed that APACHE Ⅱ≥20（OR=1.01）,length of hospital stay≥ 24d（OR=2.99）,endotracheal intubation/incision（OR= 3.50）and gastric tube implantation（OR= 3.88）were the independent risk factors for MDRAB pulmonary infection.Univariate analysis of MDRAB infection in the death group and survival group showed that that low albumin,anemia,combined respiratory failure,various drainage tubes,APACHE Ⅱ score ≥20 points at infection had statistical significance in death group and survival group（p<0.05）.There was no statistical significance in hepatic and renal insufficiency,cerebral infarction and multiple organ failure（p>0.05）.Significant factors were included in logistic multifactor regression analysis showed that APACHE Ⅱ score ≥20（OR=2.32）and various drainage tubes（OR=4.31）were independent risk factors for death of MDRAB infected patients.Conclusion1 Found that age,APACHEⅡ scores on admission,ICU admission,hypoalbuminemia,endotracheal intubation,mechanical ventilation,mechanical ventilation time/incision,infection of indwelling gastric tube,combined use of antibiotics,before using penicillium carbon alkene,infection before using aminoglycoside antibiotics drugs,infection before the use of quinolone classes and merge to other bacterial infections were dangerous factors CRAB pulmonary infection.2 APACHEⅡscore ≥20 points（OR=1.01）,length of stay ≥24d（OR=2.99）,endotracheal intubation/incision（OR= 3.50）,and gastric tube implantation（OR= 3.88）were the independent risk factors for pulmonary MDRAB in elderly patients.Drainage tube （OR=4.31）and APACHE Ⅱ score ≥20（OR=2.32）were independent risk factors for death in MDRAB patients with pulmonary infection. |
