Related risk factors of carbapenem-resistant Acinetobacter baumannii in second-level general hospitals of Sichuan province

doi:10.3877/cma.j.issn.1674-6902.2020.03.013

Abstract

Abstract:

Objective

To explore the related risk factors of carbapenem-resistant Acinetobacter baumannii in second-level general hospitals of Sichuan province.

Methods

A retrospective case-control study was performed, and the patients with Acinetobacter baumannii infection in the 6 second-level comprehensive hospitals in Sichuan province from January 2015 to January 2016 were selected for this study. According to the drug sensitivity results, the patients were divided into a carbapenem-resistant Acinetobacter baumannii (CRAB) group and a carbapenem-sensitive Acinetobacter baumannii (CSAB) group.

Results

A total of 202 strains of non-repeated Acinetobacter baumannii were collected, among which 90 strains were resistant to carbapenem. The resistance rate of Acinetobacter baumannii to carbapenem was 40.1%. There were four independent risk factors for CRAB infections: urinary catheterization (OR=9.576, 95%CI=4.964~18.474, P=0.000), central venous catheterization (OR=2.707, 95%CI=1.158~6.330, P=0.022), the use of fluoroquinolone (OR=3.869, 95%CI=1.603~9.377, P=0.003), and the application of carbapenem antibiotics (OR=2.755, 95%CI=1.164~6.521, P=0.021).

Conclusion

CRAB occurrence may be related with the invasive procedure and the selection pressure of fluoroquinolone and carbapenem antibiotics in second-level comprehensive hospitals.

Key words: Second-level general hospital, Acinetobacter baumannii, Carbapenem-resistant, Drug resistance, Risk factors

Dongmei Huang, Jun Liu, Fuxiang Li, Li Fan, Yingjie Jing, Xiao Peng and. Related risk factors of carbapenem-resistant Acinetobacter baumannii in second-level general hospitals of Sichuan province[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(03): 355-359.

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References 27

1	段　炜，范沁林，刘　勇. 替加环素对NICU碳青霉烯耐药菌致院内获得性肺炎抗感染疗效的回顾性分析[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(3): 315-320.
2	del Mar Tomas M, Cartelle M, Pertega S, et al. Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection[J]. Clin Microbiol Infect, 2005, 11(7): 540-546.
3	张建武，沈平华，郭清莲. 耐碳青霉烯类鲍曼不动杆菌的临床危险因素分析[J]. 武汉大学学报，2017, 38(5): 775-779.
4	Song JY, Cheong HJ, Noh JY, et al. In vitro Comparison of Anti-Biofilm effects against Carbapenem-resistant acinetobacter baumannii: Imipenem, colistin, tigecycline, rifampicin and combinations[J]. Infect Chemother, 2015, 47(1): 27-32.
5	姜凤丽，董亚琳，刘　东，等. ICU耐碳青霉烯类抗菌药物鲍曼不动杆菌肺部感染危险因素分析[J]. 中国药药房，2015, 9: 4077-4079.
6	俞碧霞，赵　韧，江梦娇，等. 2015年宁波市某二级医院细菌耐药性监测[J]. 中国抗生素杂志，2017, 42(1): 73-78.
7	唐小飞，谭　兵，张　艳，等. 重庆市丰都县人民医院鲍曼不动杆菌的分布特点及耐药性分析[J]. 重庆医学，2016, 45(35): 4992-4994.
8	涂　盛，邵安文，朱曼华，等. 鲍曼不动杆菌的临床分布、耐药情况及其感染危险因素分析[J]. 中国微生态学杂志，2016, 28(12): 1416-1419.
9	孙吉花，于苏国，赵爱荣，等. 耐碳青霉烯类鲍氏不动杆菌医院感染风险分析[J]. 中华医院感染学杂志，2015, 25(21): 4825-4827.
10	Lee SO, Kim NJ, Choi SH, et al. Risk Factors for acquisition of Imipenem-Resistant Acinetobacter baumannii: a Case-Control Study[J]. Antimicrob Agents Chemother, 2004, 48(1): 224-228.
11	Djordjevic ZM, Folic MM, Folic ND, et al. Risk factors for hospital infections caused by carbapanem-resistant Acinetobacter baumannii[J]. J infect Dev Ctries, 2016, 10(10): 1073-1080.
12	Lin MF, Lin YY, Lan CY. A method to assess influence of different medical tubing on biofilm formation by Acinetobacter baumannii[J]. J Microbiol Methods, 2019, 160: 84-86.
13	Alejandro C, Luis EVB, H Iván MO, et al. Immobilization of antimicrobial and anti-quorum sensing enzymes onto GMA-grafted poly (vinyl chloride) catheters [J]. Int J Pharm, 2019, 558: 72-81.
14	杨长亮，黄前川. 鲍曼不动杆菌生物膜形成的调节[J]. 中国感染控制杂志，2012, 3: 228-230.
15	殷静波，耿先龙，周丽珍，等. 2009-2012年某院耐亚胺培南鲍曼不动杆菌感染的危险因素[J]. 医疗装备，2016, 29(20): 113-114.
16	Sheng WH, Liao CH, Lauderdale TL, et al. A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii[J]. International Journal of Infectious Diseases, 2010, 14(9): e764-769.
17	费东生，曹延会，南川川，等. 耐碳青霉烯类抗生素鲍曼不动杆菌呼吸机相关肺炎的危险因素[J]. 中国老年学杂志，2013, 33(20): 4945-4948.
18	Inchai J, Liwsrisakun C, Theerakittikul, et al. Risk facors of mulitdrug-resistant, extensively, drug-resistant and pandrug-resistant Acinetobacter baumannii ventilator-associated pneumonia in a Medical Intensive Care Unit of University Hospital in Thailand[J]. J Infect Chemother, 2015, 21(8): 570-574.
19	Zorana MD, Marko MF, Nevena DF, et al. Risk factors for hospital infections caused by carbapanem-resistant Acinetobacter baumannii[J]. J Infect Dev Ctries, 2016, 10(10)：1073-1080.
20	Niu T, Xiao T, Guo L, et al. Retrospective comparative analysis of risk factors and outcomes in patients with carbapenem-resistant Acinetobacter baumannii bloodstream infections: cefoperazone-sulbactam associated with resistance and tigecycline increased the mortality[J]. Infect Drug Resist, 2018, 11：2021-2030.
21	Garcia Garmendia JL, Ortiz Leyba C, Garnacho Montero J. Risk factors for Acinetobacter baumannii nosocomial bactermia in critically ill patients: a cohort study[J]. Clin Infect Dis, 2001, 33(7): 939-946.
22	段　缓，何先弟. 耐碳青霉烯鲍曼不动杆菌感染的原因分析及护理对策[J]. 中华全科医学，2010, 8(2): 254-255.
23	卢健聪，蔡绍曦，耿穗娜，等. 耐碳青霉烯鲍曼不动杆菌医院获得性肺炎的危险因素及预后分析[J]. 中国呼吸与危重监护杂志，2009, 8(1): 24-27.
24	Ye JJ, Huang CT, Shie SS, et al. Multidrug Resistant Acinetobacter baumannii: Risk Factors for Appearance of Imipenem Resistant Strains on Patients Formerly with Susceptible Strains[J]. Plos One, 2010, 5(4): e9947.
25	Koeleman JG, Parlevliet GA, Dijkshoorn L, et al. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition[J]. J Hosp Infect, 1997, 37(2): 113-123.
26	Lortholary O, Fagon JY, Hoi AB, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis[J]. Clin Infect Dis, 1995, 20(4): 790-796.
27	王海立，隋文君，王俊瑞，等. 呼吸重症监护病房患者多重耐药鲍曼不动杆菌获得性定植的危险因素分析[J]. 中华医学杂志，2012, 92(14): 960-963.

危险因素	CRAb(n＝90)	CSAb(n＝112)	P值
年龄(岁)	66.5±15	68.4±13	0.364
女性	22(24.4)	41(36.6)	0.064
糖尿病	15(16.7)	12(10.7)	0.217
脑血管意外	19(21.1)	16(14.3)	0.203
慢性肺部疾病	26(28.9)	35(31.2)	0.716
恶性肿瘤	6(6.7)	15(13.4)	0.120
心脏病	25(27.8)	25(22.3)	0.372
肝功能不全	16(17.8)	7(6.2)	0.010
肾功能不全	14(15.6)	12(10.7)	0.307
低蛋白血症	38(42.2)	26(23.2)	0.004
住院天数(d)	15.6±11	9.2±7	0.000
入住ICU	67(74.4)	30(26.8)	0.000
入住ICU<7 d	22(24.4)	12(10.7)	0.010
入住ICU>7 d	45(50.0)	18(16.1)	0.000
住院超过30 d	12(13.3)	4(3.6)	0.011
择期或急诊手术	23(25.6)	15(13.4)	0.028
中央静脉置管	54(60.0)	19(17.0)	0.000
外科引流	10(11.1)	3(2.7)	0.015
留置尿管	72(80.0)	33(29.5)	0.000
留置胃管	58(64.4)	25(22.3)	0.000
气管切开	7(7.8)	7(6.2)	0.671
机械通气	66(73.3)	28(25.0)	0.000
机械通气<7 d	28(31.1)	17(15.2)	0.007
机械通气>7 d	38(42.2)	11(9.8)	0.000
一、二代头孢类药物的使用	10(11.1)	17(15.2)	0.398
三、四代头孢类药物的使用	37(41.1)	40(35.7)	0.432
β类酰胺酶抑制剂的使用	49(54.4)	56(50.0)	0.530
氟喹诺酮类药物的使用	26(28.9)	12(10.7)	0.001
碳青霉烯类药物的使用	29(32.2)	11(9.8)	0.000
抗菌药物使用天数(d)	11.7±6	8.0±5	0.000

危险因素	CRAb(n＝90)	CSAb(n＝112)	P值
年龄(岁)	66.5±15	68.4±13	0.364
女性	22(24.4)	41(36.6)	0.064
糖尿病	15(16.7)	12(10.7)	0.217
脑血管意外	19(21.1)	16(14.3)	0.203
慢性肺部疾病	26(28.9)	35(31.2)	0.716
恶性肿瘤	6(6.7)	15(13.4)	0.120
心脏病	25(27.8)	25(22.3)	0.372
肝功能不全	16(17.8)	7(6.2)	0.010
肾功能不全	14(15.6)	12(10.7)	0.307
低蛋白血症	38(42.2)	26(23.2)	0.004
住院天数(d)	15.6±11	9.2±7	0.000
入住ICU	67(74.4)	30(26.8)	0.000
入住ICU<7 d	22(24.4)	12(10.7)	0.010
入住ICU>7 d	45(50.0)	18(16.1)	0.000
住院超过30 d	12(13.3)	4(3.6)	0.011
择期或急诊手术	23(25.6)	15(13.4)	0.028
中央静脉置管	54(60.0)	19(17.0)	0.000
外科引流	10(11.1)	3(2.7)	0.015
留置尿管	72(80.0)	33(29.5)	0.000
留置胃管	58(64.4)	25(22.3)	0.000
气管切开	7(7.8)	7(6.2)	0.671
机械通气	66(73.3)	28(25.0)	0.000
机械通气<7 d	28(31.1)	17(15.2)	0.007
机械通气>7 d	38(42.2)	11(9.8)	0.000
一、二代头孢类药物的使用	10(11.1)	17(15.2)	0.398
三、四代头孢类药物的使用	37(41.1)	40(35.7)	0.432
β类酰胺酶抑制剂的使用	49(54.4)	56(50.0)	0.530
氟喹诺酮类药物的使用	26(28.9)	12(10.7)	0.001
碳青霉烯类药物的使用	29(32.2)	11(9.8)	0.000
抗菌药物使用天数(d)	11.7±6	8.0±5	0.000

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