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学科主题: 呼吸内科学
题名:
耐碳青霉烯鲍曼不动杆菌医院内播散和感染患者预后分析
其他题名: Intrahospital dissemination of carbapenem-resistant Acinetobacter baumannii and analysis of the infected patients' prognosis
作者: 周庆涛; 贺蓓; 姚贝; 刘振英; 张捷
关键词: 鲍曼不动杆菌 ; 药物疗法,联合 ; 抗药性 ; 交叉感染 ; 电泳,凝胶,脉冲场 ; Acinetobacter baumannii ; Drug therapy,combination ; Drug resistance ; Cross infection ; Electrophoresis,gel,pulsed-field
刊名: 北京大学学报(医学版)
发表日期: 2011
DOI: 10.3969/j.issn.1671-167X.2011.02.011
卷: 43, 期:2, 页:213-221
文章类型: Journal Article
摘要: 目的:分析2007年1月至2008年3月北京大学第三医院临床分离的耐碳青霉烯鲍曼不动杆菌的同源性,调查其定植或感染的危险因素,评价该菌所致医疗相关性感染的抗菌药物治疗.方法:通过复习病历收集耐碳青霉烯鲍曼不动杆菌定植或感染患者的临床资料.菌株的药敏试验采用纸片法,通过脉冲场凝胶电泳分析菌株的同源性.结果:研究期间共分离到49株耐碳青霉烯鲍曼不动杆菌菌株,其脉冲场凝胶电泳分型为7型,共45株(91.8%)具有同源性.分离到菌株前患者最常见的暴露因素为住ICU、侵入性操作和低白蛋白血症,最常见的合并症是慢性阻塞性肺疾病(12例)和脑血管病(10例).在这49株菌中,定植者28株,导致感染者21株,感染患者的死亡率为38.1%.Logistic回归分析发现APACHEⅡ评分是导致死亡的独立危险因素(P=0.02,OR=1.7,95%CI1.1~2.5).抗菌药物联合治疗的成功率高于单药治疗(11/13例,84.6%vs.3/17例,17.6%),尤其是头孢哌酮/舒巴坦联合左氧氟沙星联合治疗.结论:我院自2007年出现了耐碳青霉烯鲍曼不动杆菌菌株的院内播散,导致播散的危险因素为住ICU、侵入性操作、低白蛋白血症、慢性阻塞性肺疾病和脑血管病,对耐碳青霉烯鲍曼不动杆菌感染,抗菌药物联合治疗可能优于单药治疗. Objective:To assess the genetic relationship of clinical isolates of carbapenem-resistant A.baumannii (resistant to both imipenem and meropenem) from January 2007 to March 2008 in Peking University Third Hospital for measures to decrease the isolates; to investigate the characteristics of patients with carbapenem-resistant A. baumannii colonization or infection and to evaluate antibiotic treatment for health care-associated infections caused by carbapenem-resistant A. baumannii. Methods: The medical records of patients with carbapenem-resistant A. baumannii colonization or infection were reviewed. Antibiotic susceptibilities of the isolates were determined by the standardized disk-diffusion method and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis. Results: A total of 49 carbapenem-resistant A. baumannii strains were isolated from the 49 patients hospitalized during the study period and pulsed-field gel electrophoresis typing yielded 7 different patterns. A total of 45 (91.8%)genotyped strains showed clonal relationship. The most frequently identified predisposing factors were intensive care unit stay, invasive procedures, and hypoalbuminemia. Chronic obstructive pulmonary disease (12 cases) and cerebrovascular disease (10 cases) were the most common comorbid conditions.The mortality of patients with carbapenem-resistant A. baumannii infection was 38. 1% (8 of 21 patients), and the acute physiology and chronic health evaluation Ⅱ score, initial antibiotic therapy failure rate and the presence of hypoalbuminemia were significantly increased in the death group. Combination therapy regimens had higher success rates than monotherapy regimens (11/13, 84. 6% vs. 3/17,17.6%). Conclusion: There has been clonal spread of carbapenem-resistant A. baumannii strains among patients in our hospital since 2007. Intensive care unit stay, invasive procedures, hypoalbuminemia, chronic obstructive pulmonary disease and cerebrovascular disease were common in patients with carbapenem-resistant A. baumannii colonization or infection. Antibiotic combination therapy may be effective for carbapenem-resistant A. baumannii infection.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/71260
Appears in Collections:北京大学第三临床医学院_呼吸内科_期刊论文

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作者单位: 1.北京大学第三医院呼吸科,北京,100191
2.北京大学第三医院检验科,北京,100191

Recommended Citation:
周庆涛,贺蓓,姚贝,等. 耐碳青霉烯鲍曼不动杆菌医院内播散和感染患者预后分析[J]. 北京大学学报(医学版),2011,43(2):213-221.
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