Analysis Of Carbapenem-resistant Acinetobacter Bowmanii Infection And Influencing Factors Of Treatment Effect

Objective:To understand the clinical distribution of CRAB,drug resistance,risk factors of infection,difference of therapeutic schemes and influencing factors of therapeutic effect,so as to provide reference for hospital sense prevention and control and rational drug use.Method:1.A total of 104 patients with AB infection were admitted to Intensive Care Units from January 2018 to December 2020.Among them.General clinical data,specimen culture and drug sensitivity test were collected by hospital case system.The patient’s name,Sex,age,General Clinical Treatment,temperature over 38.5℃,multi-site infection(infection of two or more sites at the same time)were recorded,serum C-Reactive Protein concentration,indwelling catheterization,pre-infection antibiotics for CRAB,course of treatment,presence of cerebrovascular disease,diabetes,underlying lung disease,endotracheal intubation,APACHE II score,White Blood Cell Count×10~9/l,albumin level,steroid use,treatment outcome,length of stay,etc 2.The resistant Ab and the non-resistant AB were included in the CRAB group and the CSAB group,respectively In the study of drug efficacy and influencing factors:according to the outcome of treatment at discharge was divided into invalid group,effective group,Significantly effective group and cured group.3.SPSS23.0 statistical software was used for data analysis.Chi-square test,T-test,Mann-Whitney U test and Logistic regression equation were used to analyze the improvement of infection treatment.P<0.05 showed significant difference.Result:1.Of the 104 isolated cases of acinetobacter Bowman infection,78(75.0%)were detected as CRAB,among them,65 cases(83.33%)were sputum,6 cases(7.69%)were blood,1 case(1.28%)was urine,2 cases(2.56%)were pleural effusion,3 cases(3.84%)were abscess,and 1 case(1.28%)was other type.2.CRAB is resistant to more than 80%of all other antibiotics.3.The Crab Group consisted of 78(75.0%)of104 isolated acinetobacter Bowman infections.The rest are incorporated into the CSAB group.There were significant differences in the use of antibiotics before CRAB infection,the use of tracheal intubation during hospitalization and the length of hospitalization between the two groups(P<0.05).4.Multiple Logistic regression analysis suggested that the use of antibiotics before CRAB infection and the use of tracheal intubation during hospitalization were risk factors for CRAB infection.Binary Logistic regression analysis was used to analyze the possible factors influencing the treatment effect,the results suggest that prolonging the time of anti-infection treatment,decreasing the serum concentration of c-reactive protein,decreasing the time of deep vein puncture and Catheterization,and reducing the time of empiric medication are beneficial to improve the prognosis,old Age and the presence of underlying lung diseases such as bronchitis and other may influence the outcome of treatment for CRAB infection.6.Multiple Logistic Regression analysis showed that the serum concentration of c-reactive protein was an independent risk factor for the degree of improvement.The higher the serum concentration of c-reactive protein was,the higher the serum concentration of CRP was,the better the treatment,the greater the impact.Conclusion:1.the main risk factors for CRAB infection were the use of antibiotics andtracheal intubation prior to the CRAB infection,reducing experiential medication,reducing invasive procedures such as tracheal intubation,and shortening hospital stay will help reduce the risk of CRAB infection.2.cefoperazone Sulbactam,tigecycline and Polymyxin B all had good effects in the treatment of CRAB,but they also had different adverse reactions,therefore,in clinical practice,according to the individual situation,we choose different anti-infection treatment plans combined with various drugs,early selection of antibiotics according to drug sensitivity,appropriate extension of medication time,reduction of catheterization,reduction of indwelling blood flow catheter and other procedures to destroy the biological barrier,timely control of infection and reduce inflammation,will help reduce the production of drug-resistant bacteria and patients to obtain better treatment results.