| 摘要: |
| [摘要]目的：探讨某儿童医院重症监护室（ICU）鲍曼不动杆菌（AB）感染的临床特点及影响因素，为制定感染防控措施提供参考。方法：通过医院感染管理监测软件，收集2018年7月至2019年6月某儿童医院ICU检出的115例AB感染临床资料，回顾性分析AB分离情况、患儿年龄分布、检出部位分布、耐药情况及可能导致多重耐药菌的影响因素。结果：该院ICU检出的115例AB中，多重耐药鲍曼不动杆菌（MDRAB）70例（60.87%），以0~4岁患儿检出AB及MDRAB最多，均占80.00%，检出部位以呼吸道为主，共101例；检出的AB对复方磺胺甲恶唑敏感性最高，对青霉素类、第一代和第二代头孢菌素、部分第三代和第四代头孢菌素耐药率高，对碳青霉烯类抗菌药物耐药率达70.00%以上，对加他唑巴坦及舒巴坦等β-内酰胺酶抑制剂抗菌药物耐药率为70.00%。多因素Logistic回归分析结果显示，气管插管机械通气≧1周、留置中心静脉导管、使用碳青霉烯类抗菌药物、使用抗菌药物时间≥10 d等为AB产生多重耐药的独立危险因素（P<0.05）。结论：某儿童医院ICU中AB耐药率较高，产生MDRAB占比也较高，应完善ICU临床诊疗过程中手卫生、消毒及隔离措施，加强气管插管机械通气、留置中心静脉导管等侵入性操作及抗菌药物使用合理性的管理。 |
| 关键词: 儿童 鲍曼不动杆菌 影响因素 重症监护室 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2021.04.007 |
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| 基金项目: |
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| Clinical Characteristics and Influencing Factors of Acinetobacter Baumannii Infection in Intensive Care Unit of a Children’s Hospital |
| Li Suirong, Wang Li, Chen Junhua, Luo Qiong, He Qinghua, Duan Wenting, Dai Zhenyu, Liu Xiao, Xia Xuelin |
| (Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing 400000, China) |
| Abstract: |
| [Abstract] Objective: To probe into the clinical characteristics and influencing factors of Acinetobacter baumannii (AB) infection in intensive care unit (ICU) of a children’s hospital, so as to provide reference for the development of infection prevention and control measures. Methods: Through the software of hospital infection management and monitoring, the clinical data of 115 cases of AB infection detected in ICU of a children’s hospital from Jul. 2018 to Jun. 2019 were collected, and the status of AB separation, age and location distribution, drug resistance and influencing factors that may lead to multiple drug-resistant bacteria were investigated retrospectively. Results: Among the 115 cases of AB detected in the ICU of the hospital, 70 cases (60.87%) of multiple drug-resistant AB (MDRAB) were found. AB and MDRAB were most detected in children aged from 0 to 4 years, accounting for 80.00%. The main site of detection was respiratory tract, with a total of 101 cases. AB had the highest sensitivity to compound simvastatin, the highest resistance rate to penicillins, the first and second generation cephalosporins, part of third generation and fourth generation cephalosporins. The resistance rate to carbapenems was more than 70%, and the resistance rate to β-lactamase inhibitors such as gatazabatam and sulbactam was about 70%. Multivariate Logistic regression analysis showed that mechanical ventilation with tracheal intubation ≥1 week, indwelling central venous catheter, use of carbapenem antibiotics, use of antibiotics ≥10 d were independent risk factors for multiple drug resistance of AB (P<0.05). Conclusion: In the ICU of a children’s hospital, the drug resistance rate of AB and the proportion of MDRAB is relatively high. It is necessary to improve the hand hygiene, disinfection and isolation measures in the clinical diagnosis and treatment process of ICU, strengthen the management of invasive operation such as mechanical ventilation of tracheal intubation, indwelling central venous catheter and rational use of antibiotics. |
| Key words: children Acinetobacter baumannii influencing factors intensive care unit |
