ICU呼吸机相关性肺炎患者耐碳青霉烯鲍氏不动杆菌感染的危险因素及其耐药基因

Risk factors for carbapenem-resistant Acinetobacter baumannii infection in ICU patients with ventilator-associated pneumonia and drug resistance genes

    摘要
  • 摘要:
    目的 研究重症监护病房(ICU)呼吸机相关性肺炎(VAP)患者耐碳青霉烯鲍氏不动杆菌(CRAB)感染的危险因素及其耐药相关基因。
    方法 选取2019年11月-2022年12月简阳市人民医院收治的鲍氏不动杆菌感染VAP患者665例, 根据是否为CRAB感染分为耐药组265例和非耐药组400例, 检测CRAB携带的耐药相关基因, 分析VAP患者CRAB感染的危险因素。
    结果 265株CRAB菌株检出的耐药相关基因主要为blaOXA-51、blaADC、blaOXA-23, 检出率分别为100.00%、95.47%、79.62%；主动外排泵基因abeM、adeJ、macB和craA检出率均为100.00%；多因素分析结果显示, 白蛋白水平 < 35 g/L、格拉斯哥昏迷评分(GCS) < 8分、入住ICU时长>7 d、机械通气时长>7 d、气管切开、CRAB感染前抗菌药物使用时长>7 d、CRAB感染前抗菌药物使用种数两联及以上均为VAP患者CRAB感染的独立危险因素(P＜0.05)。
    结论 VAP患者CRAB感染危险因素较多, 分离的CRAB菌株主要耐药相关基因包括blaOXA-51、blaADC、blaOXA-23、abeM、adeJ、macB、craA、abeS、emrB、adeB、emrA。

     

    Abstract:
    OBJECTIVE To explore the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) infection in intensive care unit (ICU) patients with ventilator-associated pneumonia (VAP)and observe the drug resistance genes.
    METHODS A total of 665 VAP patients with A. baumannii infection who were treated in Jianyang People′s Hospital from Nov 2019 to Dec 2022 were enrolled in the study and were divided into the drug resistance group with 265 cases and the non-drug resistance group with 400 cases according to the status of CRAB infection. The drug resistance-related genes in the CRAB strains were detected, and the risk factors for the CRAB infection were analyzed.
    RESULTS blaOXA-51, blaADC and blaOXA-23 were the major drug resistance genes that were detected in the 265 strains of CRAB, and the detection rates were 100.00%, 95.47% and 79.62%, respectively. The detection rates of active efflux pump genes abeM, adeJ, macB and craA were 100.00%. The result of multivariate analysis showed that the albumin level less than 35 g/L, Glasgow Coma score (GCS) less than 8 points, length of ICU stay more than 7 days, duration of mechanical ventilation more than 7 days, tracheotomy, use of antibiotics for more than 7 days before the CRAB infection and two-drug or above medications before the CRAB infection were the independent risk factors for the CRAB infection in the VAP patients(P < 0.05).
    CONCLUSION There are a variety of risk factors for the CRAB infection in the VAP patients. The major drug resistance-related genes in the isolated CRAB strains include blaOXA-51, blaADC, blaOXA-23, abeM, adeJ, macB, craA, abeS, emrB, adeB and emrA.

     

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