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目的分析鲍曼不动杆菌致ICU重症患者医院获得性肺炎(HAP)的高危因素及其临床耐药情况。方法收集2013—2015年淮安市淮安医院ICU重症患者HAP 74例,其中致病菌为鲍曼不动杆菌36例(观察组),非鲍曼不动杆菌38例(对照组)。对HAP患者进行鲍曼不动杆菌感染的高危因素及耐药情况分析。结果观察组接受糖皮质激素者高于对照组(P=0.009);多因素Logistic回归分析显示,ICU重症患者HPA鲍曼不动杆菌感染的独立危险因素为接受糖皮质激素治疗[OR=5.507,95%CI(1.588~19.096),P=0.007]。观察组36例中,对头孢类、氨基糖苷类、喹诺酮类等常用抗生素耐药率大于50%,对亚胺培南耐药率最低。结论 ICU重症患者发生鲍曼不动杆菌HAP时,呈多重耐药,应评估危险因素,早期靶向治疗,规范抗生素使用。
Objective To analyze the risk factors of hospital acquired pneumonia (HAP) and its clinical drug resistance in intensive care unit (ICU) caused by Acinetobacter baumannii. Methods Totally 74 HAP patients with intensive care unit (ICU) were collected from Huai’an Hospital of Huaian in 2013-2015. Among them, 36 were Acinetobacter baumannii (observation group) and 38 were non-Acinetobacter baumannii (control group). High risk factors and drug resistance of Acinetobacter baumannii in HAP patients. Results In the observation group, glucocorticoid was higher than that in the control group (P = 0.009). Multivariate Logistic regression analysis showed that the independent risk factor of HPA in A. baumannii infection was glucocorticoid treatment [OR = 5.507, 95% CI (1.588-19.096), P = 0.007]. 36 cases of observation group, cephalosporins, aminoglycosides, quinolones and other commonly used antibiotics resistance rate of more than 50%, the lowest rate of resistance to imipenem. Conclusions In ICU critically ill patients, Acinetobacter baumannii HAP was multidrug-resistant. Risk factors, early targeted therapy and standard antibiotics should be evaluated.