98例下呼吸道鲍曼不动杆菌感染和定植患者回顾性分析.pdfVIP

·616 · CHINAJOURNALOFEMERGENCYRESUSCITATIONANDDISASTERMEDICINE July2011,Vol.6,No.7. ·论 著· 98 例下呼吸道鲍曼不动杆菌感染和定植患者回顾性分析 杨钧 程芮 公静 奚晶晶 【摘要】目的分析重症监护病房(ICU)下呼吸道鲍曼不动杆菌感染或定植的危险因素，探讨其防治策 略。方法 对武警总医院ICU2007 年1月~2009 年12月收治的98 例痰培养鲍曼不动杆菌阳性下呼吸道感 染患者进行定植或感染的初步诊断后，将病原学检测结果，临床资料，治疗措施和病情转归等进行回顾性 分析比较。结果 鲍曼不动杆菌(AB)感染者32 例，定植者66 例。AB 感染患者具有以下临床特点：长时间 使用三代头孢菌素、长时间机械通气、存在慢性肺部疾病和使用免疫抑制剂、合并低蛋白血症、高 APACHE II 评分、容易合并真菌感染。体外药敏试验提示：该菌对米诺环素敏感率为91.84% ，对其他常用 抗菌药物均高度耐药，其中对碳青霉烯类敏感率仅为21.43% ，属多重耐药不动杆菌株（MDR-A)。结论 充 分重视AB 定植和感染的鉴别，合理使用抗生素；积极改善患者的营养状况，提高患者免疫力；缩短机械通 气时间；严格消毒隔离，切断AB 水平传播途径。 【关键词】鲍曼不动杆菌；下呼吸道感染；定植；感染；重症监护病房 Infection or colonization of Acinetobacter baumannii in lower respiratory infection patients: a retrospective analysis YANG Jun*, CHENG Rui, GONG Jing , XI Jing-jing. *Department of Critical Care Medicine, General Hospital of Chinese People ’s Armed Police Forces, Beijing 100039, China Corresponding author: YANG Jun, Email: mods675509@163.com 【Abstract 】Objective To evaluate the risk factors of Acinetobacter baumannii (AB) in lower respiratory infection patients, so as to explore the diagnosis and treatment measures for AB infection and colonization. Methods The clinical data of 98 lower respiratory infection patients with AB isolated from sputum culture were analyzed to differentiate the AB infection and colonization and to explore the relevant influencing factors. Results Thirty-two patients were diagnosed as with AB infection and 66 patients were diagnosed as with AB colonization. The influencing factors of AB infection included: long-time administration of third-generation cephalosporin and mechanical ventilation, chronic lung diseases, administration of immunosuppressant, low serum albumin level, and higher scores of acute physiology and chronic health evalua