Investigation of Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Infection of Lower Respiratory Tract in Intensive Care Unit of the Second Hospital of Anhui Medical University_Chinese Journal of Evidence-Based Medicine

Authors：

 YANGMin ¹ , YINLu ¹ , LIUZhou ² , LIRuo-jie ³ , LIHui ¹ , HUATian-feng ¹ , ZHENYao ¹ , ZHANGPin-jie ¹

1. Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China;
2. Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China;
3. Department of Infection Control Section, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China;

Corresponding?author：

Keywords：

Lower respiratory tract infection; Intensive Care Unit(ICU); Multidrug-Resistant Acinetobacter Baumannii(MDR-AB); Risk factor; Prognosis

DOI：

10.7507/1672-2531.20150205

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Objective To investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. Methods Using retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. Results A total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). Conclusion The MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.

Citation： YANGMin, YINLu, LIUZhou, LIRuo-jie, LIHui, HUATian-feng, ZHENYao, ZHANGPin-jie. Investigation of Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Infection of Lower Respiratory Tract in Intensive Care Unit of the Second Hospital of Anhui Medical University. Chinese Journal of Evidence-Based Medicine, 2015, 15(11): 1241-1245. doi: 10.7507/1672-2531.20150205 Copy

1.	陳佰義, 何禮賢. 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2):76-85.
2.	Kempf M, Rolain JM. Emergence of resistance to carbapenems in Acinetobacterbaumannii in Europe:clinical impact and therapeutic options. Int J Antimicrob Agents, 2012, 39(2):105-114.
3.	葉應嫵, 王毓三, 申子瑜, 主編. 全國臨床檢驗操作規程. 第三版. 南京:東南大學出版社, 2006.
4.	Clinical and Laboratory Standards Institute (CLSI)/NCCLS. Performance standards for antimicrobial susceptibility testing standards:twentyth informational supplement, 2012, M100-S22.
5.	劉魯沂, 朱永健, 于守麗, 等. 重癥監護病房患者下呼吸道感染的流行病學調查及耐藥性分析. 中華醫院感染學雜志, 2002, 12(5): 388-390.
6.	張輝, 張小江, 徐英春, 等. 2012年中國CHINET不動桿菌屬細菌耐藥性監測. 中國感染與化療雜志, 2014, 14(5):392-397.
7.	Zheng YL, Wan YF, Zhou LY, et al. Risk factors and mortality of patients with nosocomial carbapenem-resistant Acinetobacterbaumannii pneumonia. Am J Infect Control, 2013, 41(7):e59-63.
8.	Inchai J, Liwsrisakun C, Theerakittikul T, et al. Risk factors of multidrug-resistant, extensively drug-resistant and pandrugresistant Acinetobacterbaumannii ventilator-associated pneumonia in a Medical Intensive Care Unit of University Hospital in Thailand. J Infect Chemother, 2015, 21(8):570-574.
9.	Lemos EV, de la Hoz FP, Einarson TR, et al. Carbapenem resistance and mortality in patients with Acinetobacterbaumannii infection: systematic review and meta-analysis. Clin Microbiol Infect, 2014, 20(5):416-423.
10.	譚云芳, 卓超. 耐碳青霉烯鮑曼不動桿菌耐藥機制研究進展. 廣東醫學, 2015, 36(12):1799-1802.
11.	Doi Y, Murray GL, Peleg AY. Acinetobacterbaumannii:evolution of antimicrobial resistance-treatment options. Semin Respir Crit Care Med, 2015, 36(1):85-98.
12.	Ruppé é, Woerther PL, Barbier F. Mechanisms of antimicrobial resistance in Gram-negative bacilli. Ann Intensive Care, 2015, 5(1): 61.
13.	Chen HP, Chen TL, Lai CH, et al. Predictors ofmortality in Acinetobacterbaumannii bacteremia. J MicrobiolImmunol Infect, 2005, 38(2):127-136.
14.	黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1):1-9.
15.	Garnacho-Montero J, Dimopoulos G, Poulakou G, et al. Task force on management and prevention of Acinetobacterbaumannii infections in the ICU. Intensive Care Med, 2015, 41(12):2057-2075.

1. 陳佰義, 何禮賢. 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2):76-85.
2. Kempf M, Rolain JM. Emergence of resistance to carbapenems in Acinetobacterbaumannii in Europe:clinical impact and therapeutic options. Int J Antimicrob Agents, 2012, 39(2):105-114.
3. 葉應嫵, 王毓三, 申子瑜, 主編. 全國臨床檢驗操作規程. 第三版. 南京:東南大學出版社, 2006.
4. Clinical and Laboratory Standards Institute (CLSI)/NCCLS. Performance standards for antimicrobial susceptibility testing standards:twentyth informational supplement, 2012, M100-S22.
5. 劉魯沂, 朱永健, 于守麗, 等. 重癥監護病房患者下呼吸道感染的流行病學調查及耐藥性分析. 中華醫院感染學雜志, 2002, 12(5): 388-390.
6. 張輝, 張小江, 徐英春, 等. 2012年中國CHINET不動桿菌屬細菌耐藥性監測. 中國感染與化療雜志, 2014, 14(5):392-397.
7. Zheng YL, Wan YF, Zhou LY, et al. Risk factors and mortality of patients with nosocomial carbapenem-resistant Acinetobacterbaumannii pneumonia. Am J Infect Control, 2013, 41(7):e59-63.
8. Inchai J, Liwsrisakun C, Theerakittikul T, et al. Risk factors of multidrug-resistant, extensively drug-resistant and pandrugresistant Acinetobacterbaumannii ventilator-associated pneumonia in a Medical Intensive Care Unit of University Hospital in Thailand. J Infect Chemother, 2015, 21(8):570-574.
9. Lemos EV, de la Hoz FP, Einarson TR, et al. Carbapenem resistance and mortality in patients with Acinetobacterbaumannii infection: systematic review and meta-analysis. Clin Microbiol Infect, 2014, 20(5):416-423.
10. 譚云芳, 卓超. 耐碳青霉烯鮑曼不動桿菌耐藥機制研究進展. 廣東醫學, 2015, 36(12):1799-1802.
11. Doi Y, Murray GL, Peleg AY. Acinetobacterbaumannii:evolution of antimicrobial resistance-treatment options. Semin Respir Crit Care Med, 2015, 36(1):85-98.
12. Ruppé é, Woerther PL, Barbier F. Mechanisms of antimicrobial resistance in Gram-negative bacilli. Ann Intensive Care, 2015, 5(1): 61.
13. Chen HP, Chen TL, Lai CH, et al. Predictors ofmortality in Acinetobacterbaumannii bacteremia. J MicrobiolImmunol Infect, 2005, 38(2):127-136.
14. 黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1):1-9.
15. Garnacho-Montero J, Dimopoulos G, Poulakou G, et al. Task force on management and prevention of Acinetobacterbaumannii infections in the ICU. Intensive Care Med, 2015, 41(12):2057-2075.

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Chinese Journal of Evidence-Based Medicine

Investigation of Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Infection of Lower Respiratory Tract in Intensive Care Unit of the Second Hospital of Anhui Medical University

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