Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Complex Bacteremia: A Retrospective Study in a Tertiary Hospital of West China.
Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Complex Bacteremia: A Retrospective Study in a Tertiary Hospital of West China.
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DOI：
10.1371/journal.pone.0130701
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Xie Y
中科院分区：
文献类型：
--
作者：
Liu Q;Li W;Du X;Li W;Zhong T;Tang Y;Feng Y;Tao C;Xie Y
在卫生保健机构中，鲍曼不动杆菌复合物相关感染，特别是菌血症的患病率和死亡率不断上升，对公共卫生构成了巨大威胁。我们继续调查中国大陆耐多药鲍曼杆菌复合菌血症的危险因素和预后因素。本回顾性研究于2009年1月至2013年12月在华西医院进行。利用计算机辅助微生物学实验室数据库，将耐多药鲍曼不动杆菌复合菌血症患者作为病例组，非耐多药鲍曼不动杆菌复合菌血症患者作为对照组。收集临床资料并进行分析。本研究共检出非重复鲍曼不动杆菌血分离株241株，5年多药耐药率达75.52%。多因素logistic分析显示，入住重症监护室（ICU）（调整优势比[aOR]， 5.84； 95%可信区间[CI]， 1.67-20.44）、匹兹堡菌血症评分升高（aOR, 6.55; 95% CI, 1.27-33.70）和碳青霉烯类药物的使用（aOR, 8.90; 95% CI, 1.71-46.30）是鲍曼不饱和杆菌复合菌血症患者获得耐多药的独立危险因素。年龄较大（aOR, 1.02; 95% CI, 1.00-1.04）、移植后（aOR, 5.21; 95% CI, 1.13-24.04）、匹兹堡菌血症评分较高（aOR, 2.19; 95% CI, 1.08-4.47）和白蛋白水平较低（aOR, 0.93; 95% CI, 0.88-0.99）被确定为耐多药鲍曼杆菌复合菌血症患者30天死亡率的独立危险因素。总之，我们的研究揭示了与耐多药鲍曼杆菌复合菌血症的获得和死亡相关的危险因素，这可能用于优先考虑感染控制措施和预后评估。
The increasing prevalence and mortality of multidrug-resistant (MDR) Acinetobacter baumannii complex-associated infections, especially bacteremia, in health care settings poses a great threat to public health. We proceeded to investigate the risk and prognostic factors for MDR A. baumannii complex bacteremia in mainland China. This retrospective study was conducted at West China Hospital from January 2009 to December 2013. Using a computer-assisted microbiology laboratory database, patients with MDR A. baumannii complex bacteremia were included as the case group, while those infected with non-MDR A. baumannii complex were selected as the control group. The clinical data were collected and analyzed. There were 241 non-duplicated A. baumannii complex blood isolates identified in our research, with the overall rate of multidrug resistance reaching 75.52% over the past five years. Using multivariate logistic analysis, being in the intensive care unit (ICU) (adjusted odds ratio [aOR], 5.84; 95% confidence interval [CI], 1.67-20.44), increased Pittsburgh bacteremia score (aOR, 6.55; 95% CI, 1.27-33.70) and use of carbapenem (aOR, 8.90; 95% CI, 1.71-46.30) were independent risk factors for MDR acquisition among patients with A. baumannii complex bacteremia. Older age (aOR, 1.02; 95% CI, 1.00-1.04), being post-transplantation (aOR, 5.21; 95% CI, 1.13-24.04), having a higher Pittsburgh bacteremia score (aOR, 2.19; 95% CI, 1.08-4.47) and having a lower level of albumin (aOR, 0.93; 95% CI, 0.88-0.99) were identified as independent risk factors for 30-day mortality in patients with MDR A. baumannii complex bacteremia. In conclusion, our research revealed the risk factors associated with acquisition of and mortality from MDR A. baumannii complex bacteremia, which may be used to prioritize infection control practices and prognostic evaluations.
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