某肿瘤医院ICU患者耐碳青霉烯鲍曼不动杆菌感染的危险因素及其耐药性分析OA

Objective To analyze the risk factors and drug resistance of carbapenem-resistant Acinetobacter baumannii(CRAB)infection in ICU patients of a cancer hospital.Methods The clinical data of 372 patients with Acinetobacter baumannii(A.baumannii)infection,identified through bacterial culture at the ICU of Shanxi Cancer Hospital from 2022 to 2024,were retrospectively collected.These patients were divided into the CRAB group and the non-CRAB group based on the results of carbapenem sensitivity tests.Univariate analysis was used to screen potential risk factors,and further multivariate logistic regression was employed to determine the independent risk factors for CRAB infection in ICU patients.Subsequently,the distribution of specimen sources of CRAB in ICU patients and the drug resistance to common antibacterial drugs were statistically analyzed.Results Among ICU patients,the detection rate of CRAB was 80.38%(299/372).The main source of CRAB strain specimens was sputum,accounting for 69.57%(208/299),followed by drainage fluid at 14.72%(44/299),blood at 12.37%(37/299),and urine at 3.34%(10/299).Presence of two or more underlying diseases,an Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score of≥20 at ICU admission,deep vein catheterization,tracheal intubation or incision,indwelling urinary catheter,mechanical ventilation time of≥7 d,duration of antibiotic use of≥7 d,use of carbapenem antibiotics,and use of≥2 types of antibiotics were all independent risk factors affecting CRAB infection in ICU patients(P<0.01).The resistance rate of CRAB strains isolated from ICU patients to various commonly used antibiotics exceeded 85.00%.Among them,the resistance rates to Imipenem and Meropenem were 100.00%;the resistance rates to Tigecycline,Polymyxin,and Amikacin were 13.38%,18.06%,and 57.19%,respectively.Non-CRAB strains remained highly sensitive to most antibiotics,especially Imipenem and Meropenem,which were completely sensitive,and showed high sensitivity to Tigecycline,Polymyxin,and Amikacin.Conclusion The specimens of CRAB infection strains in ICU patients mainly come from sputum.The occurrence of infection is influenced by various factors mentioned above.The CRAB strains show high sensitivity to Tigecycline and Polymyxins,but have a high resistance rate to most commonly used antibacterial drugs.