重症急性胰腺炎患者鲍曼不动杆菌感染的危险因素和耐药性分析

摘要

目的 分析重症急性胰腺炎(SAP)胰腺坏死组织感染(IPN)患者感染鲍曼不动杆菌的危险因素并分析其耐药性特点.方法 回顾性分析IPN患者61例,并根据IPN是否感染鲍曼不动杆菌分为感染组(14例)和非感染组(47例),比较两组一般情况资料,并采用Logistic回归分析患者感染鲍曼不动杆菌的危险因素.结果 SAP合并IPN患者合并鲍曼不动杆菌感染的比例为22.95％.在一般临床资料方面,两组患者在性别、病因、并存症等方面均差异无统计学意义(P＞0.05).但相比于非感染组,感染组患者平均年龄更大[(43.31 ±13.05)岁vs (52.43 ±13.01)岁],CT严重度(CTSI)评分更高[(7.49±1.58)分vs (9.00±1.52)分],急性呼吸窘迫综合征(ARDS)(27.66％ vs 64.28％)及休克(36.17％vs71.42％)的发生率更高,入院急性生理与慢性健康(APACHE)Ⅱ评分更高[(13.57±3.45)分vs(17.13 ±3.78)分],并发脓毒症(17.02％ vs 42.85％)比例更高,ICU天数[(20.17±10.98)dvs(35.93±14.97)d]及住院天数[(32.77±22.08) dvs (48.71 ±18.67)d]更长,均差异有统计学意义(P＜0.05).Logistic回归分析结果显示,IPN感染鲍曼不动杆菌的危险因素包括年龄、CTSI评分、APACHEⅡ评分、ICU天数及住院天数.在耐药性方面发现,鲍曼不动杆菌对头孢类及碳青霉烯类抗生素耐性高.结论 IPN感染鲍曼不动杆菌的危险因素包括年龄、CTSI评分、APACHEⅡ评分、ICU天数及住院天数.且其对头孢类及碳青霉烯类抗生素耐性高.%Objective To analysis the risk factors and drug resistance characteristics of acinetobacter baumannii infection in severe acute pancreatitis(SAP) patients complicated with infected pancreatic necrosis (IPN).Methods We retrospectively reviewed 61 patients diagnosed with IPN.And patients were divided into infection group (14 cases) and none-infection group (47 cases) according to whether complicated with acinetobacter baumannii infection.Risk factors of acinetobacter baumannii infection were analyzed through logistic regression analysis.Results The proportion of acinetobacter baumannii infection in IPN patients in our hospital was 22.95％.In the aspect of clinical characteristics,no significant statistical differences (P ＞ 0.05) were found in gender,etiology,complications et al.However,when compared with none-infection group,infection group showed older aged (43.31 ± 13.05) vs (52.43 ± 13.01),more severe of CT severity index (CTSI) (7.49 ± 1.58) vs (9.00 ± 1.52),higher proportion of ARDS(27.66％ vs 64.28％),shock (36.17％ vs 71.42％)and higher APACHE Ⅱ score (13.57 ± 3.45) vs (17.13 ± 3.78) and complicatcd with higher proportion of sepsis (17.02％ vs 42.85％).Also,with longer ICU stays (20.17 ± 10.98) vs (35.93 ± 14.97) and hospital stays (32.77 ± 22.08) vs (48.71 ± 18.67).Logistic regression analysis results showed that risk factors of acinetobacter baumannii infection included older age,higher CTSI and APACHE Ⅱ score,and prolonged ICU and hospital stays.Drug resistance analysis indicated that acinetobacter baumannii had high resistance in cephalosporin and carbapenem.Conclusions Risk factors of IPN patients complicate with acinetobacter baumannii infection include older age,higher CTSI and APACHEII score,and prolong ICU and hospital stays and hashigh resistance in cephalosporin and carbapenem.