30-day mortality risk and risk factors of patients with carbapenem resistant <i>Acinetobacter baumannii</i> in intensive care unit_West China Medical Journal

Authors：

ZHANG Huarong ¹ , LÜ Yu ² ,  JIANG Xiaoyan ²

1. Department of Infection Management, People’s Hospital of Yilong County, Yilong, Sichuan 637699, P. R. China;
2. Healthcare-Associated Infections Control Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610070, P. R. China;

Corresponding author：

JIANG Xiaoyan, Email: 29381636@qq.com

Keywords：

Carbapenem-resistant Acinetobacter baumanni; mortality risk; risk factors

DOI：

10.7507/1002-0179.202211128

Video：

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Objective To analyze the clinical characteristics, mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii (CRAB), so as to provide references for the prevention and control of CRAB. Methods Inpatients with Acinetobacter baumannii were selected from the clinical samples in the intensive care unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital between January 2018 and December 2021. The patients were divided into CRAB infection group, carbapenem-sensitive Acinetobacter baumannii (CSAB) infection group and CRAB colonization group. Survival analysis was used to analyze the mortality risk and its influencing factors in patients with CRAB infection. Results A total of 696 patients were included. Among them, there were 392 cases of CRAB infection, 267 cases of CRAB colonization, and 37 cases of CSAB infection. The factors that increased the 30-day mortality risk of CRAB mainly included blood transfusion or use of blood products, mechanical ventilation, respiratory failure, maximum procalcitonin and age. Kaplan-Meier analysis showed that the 30-day mortality risk of CRAB infection group was higher than that of CSAB infection group（χ²=4.837, P=0.028), there was no significant difference between CRAB infection group and CRAB colonization group in 30-day mortality risk（χ²=0.219, P=0.640). Conclusions The mortality risk of CRAB infected patients is higher. Compared with the infection status, the 30-day mortality risk of patients is more attributed to drug resistance status. The effective method to control the mortality rate of CRAB should focus on reducing the hospital acquisition rate of CRAB.

Citation： ZHANG Huarong, LÜ Yu, JIANG Xiaoyan. 30-day mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii in intensive care unit. West China Medical Journal, 2023, 38(3): 358-363. doi: 10.7507/1002-0179.202211128 Copy

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19.	杨启文, 吴安华, 胡必杰, 等. 临床重要耐药菌感染传播防控策略专家共识. 中国感染控制杂志, 2021, 20(1): 1-14.
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21.	Longo F, Vuotto C, Donelli G. Biofilm formation in Acinetobacter baumannii. New Microbiol, 2014, 37(2): 119-127.
22.	赵永鑫, 王晓红, 王英, 等. 耐碳青霉烯类鲍曼不动杆菌同源性及生物膜形成能力分析. 微生物学杂志, 2019, 39(4): 65-70.
23.	吕宇, 刘华, 王慧, 等. 神经外科重症监护病房医院感染目标性监测分析. 华西医学, 2014, 29(10): 1908-1911.
24.	孔海芳, 胡志东. 碳青霉烯耐药鲍曼不动杆菌的临床特征及克隆变迁. 天津医科大学学报, 2020, 26(5): 471-475.
25.	黄文治, 乔甫, 王妍潼, 等. 耐碳青霉烯类鲍曼不动杆菌血流感染患者危险因素及预后. 中国感染控制杂志, 2015, 14(10): 668-671.
26.	陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中国医药科学, 2012, 2(8): 3-8.
27.	中华预防医学会医院感染控制分会中华医学会感染病学分会中国医院协会医院感染管理专业委员会. 中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引. 中华医院感染学杂志, 2019, 29(13): 2075-2080.
28.	Madden GR, Sifri CD. Antimicrobial resistance to agents used for staphylococcus aureus decolonization: is there a reason for concern?. Curr Infect Dis Rep, 2018, 20(8): 26.
29.	Siegel JD, Rhinehart E, Jackson M, et al. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control, 2007, 35(10 Suppl 2): S165-S193.
30.	赖永才, 吕宇, 刘淼, 等. 同种异体输血相关医院感染的危险因素. 中华医院感染学杂志, 2021, 31(18): 2788-2792.
31.	Hart S, Cserti-Gazdewich CM, McCluskey SA. Red cell transfusion and the immune system. Anaesthesia, 2015, 70(Suppl 1): 38-45,e13-e16.
32.	李瑛, 吕宇, 杨陵. 耐碳青霉烯类革兰阴性菌检出患者 30 d 病死风险影响因素. 中华医院感染学杂志, 2020, 30(18): 2749-2753.
33.	何磊, 姜道彬. 耐碳青酶烯类鲍曼不动杆菌感染患者死亡危险因素调查. 广西医科大学学报, 2020, 37(5): 917-921.

1. Pogue JM, Mann T, Barber KE, et al. Carbapenem-resistant Acinetobacter baumannii: epidemiology, surveillance and management. Expert Rev Anti Infect Ther, 2013, 11(4): 383-393.
2. Tacconelli E, Carrara E, Savoldi A, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis, 2018, 18(3): 318-327.
3. 孙双勇, 王蒙蒙, 李丽, 等. 抗生素耐药与抗生素新药开发的研究进展. 现代药物与临床, 2022, 37(2): 221-229.
4. 李六亿. 标准预防—防控多重耐药菌感染的基本策略. 中国护理管理, 2019, 19(8): 1121-1125.
5. 胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三级医院细菌耐药监测. 中国感染与化疗杂志, 2020, 20(3): 233-243.
6. 陈美恋, 胡必杰, 吴安华, 等. 综合医院 ICU 患者耐碳青霉烯类鲍氏不动杆菌医院感染流行病学特点分析. 中华医院感染学杂志, 2015, 25(21): 4819-4821.
7. Ye D, Shan J, Huang Y, et al. A gloves-associated outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit in Guangdong, China. BMC Infect Dis, 2015, 15(1): 179.
8. 医院感染诊断标准(试行)转载(2). 中华医院感染学杂志, 2001, 11(4): 1.
9. 王惠, 吕宇, 向钱, 等. 医院感染病例漏报的前瞻性监测与控制. 中国感染控制杂志, 2018, 17(11): 1022-1025.
10. 中华人民共和国卫生部. WS/T 312-2009 医院感染监测规范, 2009.
11. 许蓓妮, 陈敏珊, 伍国达, 等. 外科术后耐碳青霉烯类鲍曼不动杆菌感染的危险因素分析. 新医学, 2019, 50(1): 47-50.
12. 王瑞峰, 曹大伟, 张新日. 我国耐碳青霉烯类鲍曼不动杆菌医院感染危险因素的 Meta 分析. 安徽医药, 2020, 24(11): 2121-2127.
13. 蒋俊杰, 刘正东, 王法财, 等. 重症监护室耐碳青霉烯类鲍曼不动杆菌致医院获得性肺炎抗感染疗效评价. 中国药业, 2018, 27(22): 82-85.
14. 中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018 年修订版). 中国心血管杂志, 2019, 24(1): 24-56.
15. 中华医学会糖尿病学分会. 中国 2 型糖尿病防治指南(2010 年版). 中国医学前沿杂志(电子版), 2011, 3(6): 54-109.
16. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中国医学前沿杂志(电子版), 2014, 6(2): 67-80.
17. 刘启蒙, 叶寰. 耐碳青霉烯类革兰阴性菌肺炎的发生及死亡风险因素分析. 临床荟萃, 2019, 34(4): 334-338.
18. 张成, 彭源, 罗小强, 等. 2015—2019 年某院重症监护病房病原菌分布及耐药性. 中华医院感染学杂志, 2021, 31(21): 3240-3245.
19. 杨启文, 吴安华, 胡必杰, 等. 临床重要耐药菌感染传播防控策略专家共识. 中国感染控制杂志, 2021, 20(1): 1-14.
20. Jiang X, Ellabaan MMH, Charusanti P, et al. Dissemination of antibiotic resistance genes from antibiotic producers to pathogens. Nat Commun, 2017, 8: 15784.
21. Longo F, Vuotto C, Donelli G. Biofilm formation in Acinetobacter baumannii. New Microbiol, 2014, 37(2): 119-127.
22. 赵永鑫, 王晓红, 王英, 等. 耐碳青霉烯类鲍曼不动杆菌同源性及生物膜形成能力分析. 微生物学杂志, 2019, 39(4): 65-70.
23. 吕宇, 刘华, 王慧, 等. 神经外科重症监护病房医院感染目标性监测分析. 华西医学, 2014, 29(10): 1908-1911.
24. 孔海芳, 胡志东. 碳青霉烯耐药鲍曼不动杆菌的临床特征及克隆变迁. 天津医科大学学报, 2020, 26(5): 471-475.
25. 黄文治, 乔甫, 王妍潼, 等. 耐碳青霉烯类鲍曼不动杆菌血流感染患者危险因素及预后. 中国感染控制杂志, 2015, 14(10): 668-671.
26. 陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中国医药科学, 2012, 2(8): 3-8.
27. 中华预防医学会医院感染控制分会中华医学会感染病学分会中国医院协会医院感染管理专业委员会. 中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引. 中华医院感染学杂志, 2019, 29(13): 2075-2080.
28. Madden GR, Sifri CD. Antimicrobial resistance to agents used for staphylococcus aureus decolonization: is there a reason for concern?. Curr Infect Dis Rep, 2018, 20(8): 26.
29. Siegel JD, Rhinehart E, Jackson M, et al. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control, 2007, 35(10 Suppl 2): S165-S193.
30. 赖永才, 吕宇, 刘淼, 等. 同种异体输血相关医院感染的危险因素. 中华医院感染学杂志, 2021, 31(18): 2788-2792.
31. Hart S, Cserti-Gazdewich CM, McCluskey SA. Red cell transfusion and the immune system. Anaesthesia, 2015, 70(Suppl 1): 38-45,e13-e16.
32. 李瑛, 吕宇, 杨陵. 耐碳青霉烯类革兰阴性菌检出患者 30 d 病死风险影响因素. 中华医院感染学杂志, 2020, 30(18): 2749-2753.
33. 何磊, 姜道彬. 耐碳青酶烯类鲍曼不动杆菌感染患者死亡危险因素调查. 广西医科大学学报, 2020, 37(5): 917-921.

West China Medical Journal

30-day mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii in intensive care unit

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