[Analysis of drug resistance of Acinetobacter baumannii and its related factors in ICU]

Abstract

Objective: To investigate drug resistance of Acinetobacter baumannii and its related factors in intensive care unit (ICU), and to provide clinical basis for prevention and treatment.

Methods: A retrospective analysis was conducted. Clinical data was collected from 1 050 patients in ICU of Foshan Hospital of Traditional Chinese Medicine from January 2011 to June 2013. The risk factors of nosocomial infection were analyzed with univariate analysis. The independent risk factor was sieved from the risk factors with P<0.05 with unconditional logistic regression analysis to analyze the related factors and drug resistance of Acinetobacter baumannii in ICU.

Results: One hundred and thirteen patients suffering from nosocomial infection of Acinetobacter baumannii were found, and its incidence rate was 10.76%. There were 96 cases of infection of multi-drug resistant, extensive-drug resistant and pan-drug resistant Acinetobacter baumannii, accounting for 84.96%. Acinetobacter baumannii detection rate was 79.65% in sputum, 10.62% in urine, 4.42% in wound secretion, 3.54% in blood, and 1.77% in other drainage discharges, respectively. Univariate analysis showed that mechanical ventilation, ICU stay time≥7 days, coma [Glasgow coma score (GCS)<8], usage of broad-spectrum antibiotics were risk factors of nosocomial infection of Acinetobacter baumannii. Multivariate logistic analysis showed that the independent risk factors of nosocomial infection caused by Acinetobacter baumannii in ICU were mechanical ventilation [odds ratio (OR)= 2.957, 95%confidence interval (95%CI) 1.106-6.253, P=0.023], ICU stay time≥7 days (OR=2.991, 95%CI 1.135-6.544, P=0.022), coma (GCS<8,OR=2.894, 95%CI 1.803-7.462, P=0.010), and usage of broad-spectrum antibiotics (OR=3.054, 95%CI 1.009-6.550, P=0.004). Rate of resistance to polymyxin B was the lowest (6.19%), and it was followed by tobramycin and tigecycline, 11.50% and 28.32%, respectively.

Conclusions: Acinetobacter baumannii in ICU was conditional pathogenic bacteria with high infection rate, and the lower respiratory tract was the main site of infestation. The related factors include mechanical ventilation, ICU stay time, coma, usage of broad-spectrum antibiotics. Its antimicrobial resistance rate was high. Comprehensive measures, including environmental isolation, strict bed unit disinfection, enforcement of hand disinfection, strengthening the effort to shorten the duration of mechanical ventilation, reduction of ICU length of stay, enhancement of drainage of mucus, excretions, and other body fluids, and rational use of antibiotics should be encouraged in order to reduce Acinetobacter baumannii in ICU.