Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii:: a case-control study
Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii:: a case-control study
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DOI：
10.1128/aac.48.1.224-228.2004
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发表时间：
2004-01-01
影响因子：
4.9
通讯作者：
Kim, YS
中科院分区：
文献类型：
--
作者：
Lee, SO;Kim, NJ;Kim, YS
目的：探讨耐亚胺培南鲍曼不动杆菌(IRAB)医院感染的危险因素。采用病例对照研究设计，对两组鲍曼不动杆菌阳性患者和对照患者进行比较。从第一组鲍曼不动杆菌阳性患者中分离出医院内的IRAB，从第二组中分离出亚胺培南敏感的鲍曼不动杆菌(ISAB)。对照患者以4：1的比例随机选择，这些患者来自鲍曼不动杆菌阳性患者在发生IRAB分离时接受护理的相同内科或外科服务。分析的危险因素包括人口统计变量、合并症、与住院相关的变量以及使用的抗菌药。2000年1月至12月期间，从104名患者中分离出IRAB，从387名患者中分离出ISAB。发生IRAB的危险因素为既往ICU病史(优势比为21.54；95%可信区间为10.73~43.23)和既往接触亚胺培南(OR为9.18；95%CI为3.99~21.13)或第三代头孢菌素类药物(OR为2.11；95%CI为1.13~3.95)。ISAB的危险因素是有ICU病史(OR，8.05；95%CI，5.67至11.44)和接触第三代头孢菌素(OR，2.07；95%CI，1.47至2.91)。我们的结果表明，IRAB或ISAB的医院发生与ICU住院时间密切相关，而IRAB的发生可能受到亚胺培南的选择压力的影响。
Risk factors for the nosocomial occurrence of imipenem-resistant Acinetobacter baumannii (IRAB) were determined. A case-control study design was used for a comparison of two groups of A. baumannii-positive patients with control patients. Nosocomial IRAB was isolated from the first group of A. baumannii-positive patients, and imipenem-susceptible A. baumannii (ISAB) was isolated from the second group. The control patients were randomly selected in a 4:1 ratio from the same medical or surgical services from which the A. baumannii-positive patients were receiving care when the isolation of IRAB occurred. Risk factors analyzed included demographic variables, comorbid conditions, variables related to hospitalization, and the antimicrobials used. IRAB was isolated from 104 patients, and ISAB was isolated from 387 patients between January and December 2000. The risk factors for IRAB were a previous intensive care unit (ICU) stay (odds ratio [OR], 21.54; 95% confidence interval [CI], 10.73 to 43.23) and prior exposure to imipenem (OR, 9.18; 95% CI, 3.99 to 21.13) or third-generation cephalosporins (OR, 2.11; 95% CI, 1.13 to 3.95). Risk factors for ISAB were a previous ICU stay (OR, 8.05; 95% CI, 5.67 to 11.44) and exposure to third-generation cephalosporins (OR, 2.07; 95% CI, 1.47 to 2.91). Our results suggest that the nosocomial occurrence of IRAB or ISAB is strongly related to an ICU stay, and IRAB occurrence may be favored by the selection pressure of imipenem.