Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit.
Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit.
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DOI：
10.3346/jkms.2012.27.8.939
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发表时间：
2012-08
影响因子：
4.5
通讯作者：
Park MS
中科院分区：
文献类型：
--
作者：
Kim SY;Jung JY;Kang YA;Lim JE;Kim EY;Lee SK;Park SC;Chung KS;Park BH;Kim YS;Kim SK;Chang J;Park MS
为评估重症监护病房（ICU）耐碳青霉烯类鲍曼不动杆菌（CRAB）菌血症的危险因素和螃蟹菌血症患者30天死亡率，我们于2008年1月至2009年12月在韩国Severance医院ICU进行了回顾性研究。在ICU获得CRAB菌血症的患者作为病例组，血培养、痰/气管内抽吸和尿液标本均未发现AB的患者作为对照组。病例组106例，对照组205例。与CRAB菌血症独立相关的危险因素包括：既往化疗或放疗（优势比[or]， 3.6; P = 0.003）、近期中心静脉置管（优势比[or]， 5.7; P < 0.001）或腹腔引流管（优势比[or]， 21.9; P = 0.004）、使用抗生素的次数（优势比[or]， 1.3; P = 0.016）、ICU呼吸衰竭（优势比[or]， 2.5; P = 0.035）。30天死亡率为79.8%。ICU住院期间肾功能衰竭与30天死亡率独立相关（OR, 3.7; P = 0.047）。重要的是要尽量减少侵入性手术，并限制抗生素的过度使用，特别是在免疫功能低下的患者中，以防止螃蟹菌血症的发展。当在ICU住院期间出现肾功能衰竭时，需要更多地关注螃蟹菌血症患者。
To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.
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