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.	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. 中华医学杂志, 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.	叶应妩, 王毓三, 申子瑜, 主编. 全国临床检验操作规程. 第三版. 南京:东南大学出版社, 2006.
4.	Clinical and Laboratory Standards Institute (CLSI)/NCCLS. Performance standards for antimicrobial susceptibility testing standards:twentyth informational supplement, 2012, M100-S22.
5.	刘鲁沂, 朱永健, 于守丽, 等. 重症监护病房患者下呼吸道感染的流行病学调查及耐药性分析. 中华医院感染学杂志, 2002, 12(5): 388-390.
6.	张辉, 张小江, 徐英春, 等. 2012年中国CHINET不动杆菌属细菌耐药性监测. 中国感染与化疗杂志, 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.	谭云芳, 卓超. 耐碳青霉烯鲍曼不动杆菌耐药机制研究进展. 广东医学, 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.	黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 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. 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. 中华医学杂志, 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. 叶应妩, 王毓三, 申子瑜, 主编. 全国临床检验操作规程. 第三版. 南京:东南大学出版社, 2006.
4. Clinical and Laboratory Standards Institute (CLSI)/NCCLS. Performance standards for antimicrobial susceptibility testing standards:twentyth informational supplement, 2012, M100-S22.
5. 刘鲁沂, 朱永健, 于守丽, 等. 重症监护病房患者下呼吸道感染的流行病学调查及耐药性分析. 中华医院感染学杂志, 2002, 12(5): 388-390.
6. 张辉, 张小江, 徐英春, 等. 2012年中国CHINET不动杆菌属细菌耐药性监测. 中国感染与化疗杂志, 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. 谭云芳, 卓超. 耐碳青霉烯鲍曼不动杆菌耐药机制研究进展. 广东医学, 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. 黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 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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