| Objective:To analyze the drug resistance,clinical characteristics and prognostic risk factors of Acinetobacter baumannii(AB)bloodstream infection(BSI),and provide evidence for clinical prognosis evaluation.Methods:A total of 98 inpatients with AB bloodstream infection from September 2017 to August 2020 were included in the First Affiliated Hospital of Anhui Medical University.Their clinical data were collected,and drug resistance was analyzed.They were divided into poor prognosis group(57 cases)and improved prognosis group(41cases),and their prognostic risk factors were analyzed by using SPSS25.0 software.Results:1.Among 98 inpatients with AB bloodstream infection,59 inpatients were males and 39 inpatients were females;Aged 18 to 93 years old,and the average age was(56.93±17.03);The minimum length of hospital stay was 2 days and the maximum was 141 days,the average length of hospital stay was(36.97±26.43)days.Among them,78 patients had admitted to intensive care unit(ICU).2.AB bloodstream infection was distributed in 14 clinical departments.The separation rate of the bacteria in ICU was the highest,up to 52.04%(51/98),followed by cardiovascular surgery(including cardiac surgical care unit),accounting for 24.49%(24/98).The most common primary disease at admission was cardiovascular disease,accounting for 26.53%(26/98),followed by cerebrovascular disease and digestive system disease,both were 17.35%(17/98).Most patients had multiple basic diseases,renal insufficiency and cardiac insufficiency were the most common;64 patients had a history of surgery within 3 months,especially cardiac and intracranial operations.3.95 patients had fever as the first symptom.At the same time,1 patient had a normal temperature,and 2 patients had hypothermia.All patients were scored on admission according to the APACHE II scoring criteria,the highest score was 30 and the lowest was 2.4.The drug resistance rate of Acinetobacter baumannii to tigecycline and polymyxin B was relatively low(less than 10%),the second is minocycline,which was18.29%.The resistance rate of imipenem and meropenem was both high,which was88.78% and 87.76% respectively.Among them,the detection rate of pan drug resistant Acinetobacter baumannii(XDRAB)was 88.78%(87/98),and the rate of poor prognosis was 59.78%.In the past three years,the detection rate of XDRAB in our hospital remained at a high level,mainly in ICU,and the detection rate of pan drug resistant strain was 94.12%.5.In general poor prognosis group had 57 cases(35 patients died in hospital and22 patients gave up treatment),improved group had 41 cases,and the poor prognosis rate was 59.8%.The univariate analysis found that there were statistically significant differences in APACHE II score at admission,multiple organ dysfunction syndrome(MODS),unreasonable use of antibiotic before reporting positive,invasive operation,ICU admission,respiratory failure,cardiac insufficiency,renal insufficiency,and hypoproteinemia(all P<0.05).The multivariate logistic regression analysis showed that APACHE II score at admission(OR=1.138,95%CI 1.01-1.282,P=0.034),MODS(OR=8.491,95%CI 2.068-34.861,P=0.003),and unreasonable use of antibiotic before reporting positive(OR=7.19,95%CI 1.727-29.93,P=0.007)were independent risk factors for AB bloodstream infection.Conclusion :AB Bloodstream infection often occurred in ICU,and it was closely associated with cardiovascular diseases.AB in bloodstream infection was extensively drug resistant,with enhanced virulence and poor prognosis.High APACHE II score at admission,MODS,and unreasonable use of antibiotic before reporting positive were independent risk factors for AB bloodstream infections.We should strengthen the prevention and control nosocomial infection.Clinicians should pay more attention to patients,especially with MODS and high APACHE II score at admission.And we should use reasonable antibiotics early. |
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