中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

泛耐药鲍曼不动杆菌菌血症的临床特点及预后

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目的 对重症监护病房泛耐药鲍曼不动杆菌菌血症的临床特点及预后进行总结。 方法 回顾性研究 2012 年 1 月至2015 年 12 月 31 日北京大学第一院呼吸监护室的鲍曼不动杆菌菌血症患者,收集患者人口学特点、临床资料、3 d 及 14 d 的预后。 结果 纳入 8 例患者,平均年龄(62.4±18.0)岁,男 3 例,女 5 例。所有患者均患有基础疾病,6 例为免疫抑制患者,7 例患者发病前 2 周内接受含有 β 内酰胺酶抑制剂的复合制剂或碳青霉烯类抗菌药物,6 例接受机械通气,肺脏是主要病源。菌种鉴定均为泛耐药鲍曼不动杆菌。患病 48 h 内平均急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分为(28.3±7.5)分,C 反应蛋白(18.2~231.0 mg/L)和降钙素原(0.1~25.0 ng/ml)个体差异较大。3 d 死亡率为 4/8,均为 APACHEⅡ>25 分的患者;14 d 死亡率为 6/8,PCT>0.5 ng/ml 的患者均死亡。 结论 泛耐药鲍曼不动杆菌菌血症患者 14 d 的预后和疾病严重程度及降钙素原升高有关。对于 APACHE Ⅱ>25 分、降钙素原升高、之前接受机械通气的高度可疑患者应考虑在血培养结果回报前抢先治疗。

Objective To summarize the clinical features and prognosis of extensively drug-resistant Acinetobacter baumannii (XDRAB) bacteremia. Methods This retrospective study included patients with Acinetobacter baumannii bacteremia diagnosed and treated in RICU of this hospital during January 1, 2012 and December 31, 2015. Demographic features, clinical data, clinical outcome within 3 days and 14 days after sample collection for blood culture were collected. Results Eight patients were included, with the mean age of (62.4±18.0) years, and including 3 males and 5 females. All patients had underlying diseases, 6 patients were immune suppressed, 7 patients had been exposed to β-lactam/enzyme inhibition or carbapenems for at least 7 days within 2 weeks before blood sample collection, and 6 patients received mechanical ventilation. Lung is the main pathogen source (6 cases). Within 48 hours after blood collection, the mean acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score was 28.3±7.5, the level of serum C-reactive protein (18.2 to 231.0 mg/L) and procalcitonin (0.1 to 25.0 ng/ml) had individual differences. The 3-day mortality rate was 4/8, the death group had APACHEⅡ >25. The 14-day mortality rate was 6/8, all the patients with procalcitionin>0.5 ng/ml died. Conclusions The 14-Day mortality is associated with the severity and increased procalcitionin in XDRAB patients. Preemptive therapy is recommend for patients with multiple risk factors, receiving mechanical ventilation, and with elevated procalcitonin and high APACHEⅡ score ( >25).

关键词: 泛耐药鲍曼不动杆菌; 菌血症; 预后

Key words: Acinetobacter baumannii; Extensively drug-resistant bacteremia; Prognosis

引用本文: 廖纪萍, 阙呈立, 孙立颖, 金哲, 马靖, 王广发. 泛耐药鲍曼不动杆菌菌血症的临床特点及预后. 中国呼吸与危重监护杂志, 2017, 16(5): 436-440. doi: 10.7507/1671-6205.201612055 复制

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