Preliminary Analysis On The Treatment Of Ventilator-associated Pneumonia Caused By Extensively Drug-resistant Acinetobacter Baumannii

Recently, Clinical infections caused by Acinetobacter baumanii become more and more. Both the degree of infection and site of infection are on the rise, which bring many difficulties to infection control. Acinetobacter baumannii(Ab) is a kind of gram-negative bacteria, conditional pathogenic bacteria. It widely exists in the medical environment, and has strong vitality and transmissibility. With the wide application of large amounts of antibiotics and the new advent arising, it makes Ab in the infection rate of hospital acquired infection and resistance rate increased year by year. At the same time, the drug-resistant spectrum of Ab is incredibly changing, appearing multiple drug resistance(extensively drug acinetobacter baumanii, XDR- Ab) or "full" resistance of acinetobacter baumannii(Pandrug resistant acinetobacter baumanii, PDR- Ab). On the distribution of acinetobacter baumannii in nosocomial infection trend at home and abroad, all kinds of intensive care unit of Ab infection rate is the highest, headed by the respiratory intensive care unit. Ab is the most common infection of the lungs, and becomes the important pathogens of Ventilator associated Pneumonia. Ventilator-associated Pneumonia refers to patients who have pneumonia because of receive mechanical ventilation at 48~72 hours and even more. VAP is a kind of clinical infection difficult to control, and has high case fatality rate of disease. But VAP caused by XDR-Ab adds more difficulty to clinical work as well as the great difficulty in clinical treatment. Latest experts put forward the application of tigecycline to cure VAP caused by XDR-Ab. Tigecycline is a new generation of tetracycline class of antibiotics. Tigecycline is a new kind of antibiotics, it has any studies on the treatment of VAP caused by XDR-Ab. But because of differences of various regional medical degree and level of economic development, the patient’s exposure environment, so tigecycline in the clinical curative effect on the treatment of the disease will have differences.ObjectSo this study retrospectively analysis the local clinical curative treatment effect of VAP caused by XDR-Ab using carbapenems antibiotics as control study, and tigecycline is analyzed emphatically in the treatment of the pneumonia curative effect and prognosis. Hoping the local hospital has certain significance of guiding treatment in VAP caused by XDR-Ab.MethodThe object of this study was to investigate the outcome of 117 cases of patients in many hospitals(The second hospital of hebei medical university、The third hospital of hebei medical university、The traditional hospital of Shijiazhuang、The center hospital of handan) between October 2013 and October 2014 diagnosed with multiple drug resistance in ventilator associated pneumonia caused by XDR-Ab. Based on patients with application of anti-infection drugs, they were divided into two groups A and B retrospectively. Group A had 46 cases, tigecycline was involved in the process of anti-infection application. Group B had 71 cases, carbapenems antibiotics were used as mainly antibiotics. Recorded patients’ basic situation, including gender, age, GCS score, APACHE score, and mechanical ventilation time and strain culture positive before hospitalization days, etc. Recorded the patients’ clinical conditions during treatment(symptoms, signs and auxiliary examination), and follow-up of the 28 days after discharge of the prognosis. To collect and analyze data, and put all data through Excel input, using the SPSS 21.0 statistical software for statistical analysis. To text statistical difference among the data obtained by the x2 test, t-test, basic clinical characteristics of the comparison between the two groups, and to text the two groups of drug treatment for clinical curative effect of VAP caused by XDR-Ab, and carried out a statistical analysis on the curative effect and prognosis of bacteriology, P < 0.05 for the difference was statistically significant.Results1 Patients clinical characteristics117 cases of patients who diagnosed with multiple drug resistance in VAP caused by XDR-Ab were divided into two groups A and B. With male 34 cases and female 12 cases in Group A. With male 52 cases and female 19 cases in Group B. The average age of group A was 57.13 years. The average age of group B was 57.86 years. Group A have 24 patients with trachea cannula and have 22 patients with incision of tracheal. Group B have 44 patients with trachea cannula and have 27 patients with incision of tracheal. With 12 cases utilization hormone in treatment of group A. With 19 cases utilization hormone in treatment of Group B. Group A have 17 patients with combination fungus infection, and group B have 21 patients. 18 cases have utilization antibacterial before enter ICU of group A and the same patients in the group B have 21 cases. Group A have 25 cases with smoking history, group B have 30 cases with smoking history. Group A have 7 patients with polyinfection, and group B have 9 patients. The clinical characteristics of two groups had no statistical significance in addition to treatment protocols(P > 0.05).2 Treatment protocols46 cases in group A used tigecycline as treatment, and their course of the treatment was(10.587±3.727)days. 71 cases in group B used carbapenems antibiotics as treatment, and their course of treatment was(8.775±4.599)days.3 Clinical curative effect: 32 cases were markedly effective, 14 cases were ineffective in Group A. The clinical effective rate was 69%. 20 cases were markedly improved, invalid 51 cases in Group B, and clinical effective rate was 28%. Difference between the two groups was statistically significant(P < 0.05).4 The curative effect of bacteriology: 32 cases were cleared, 14 cases were not, bacterial clearance rate was 69% in Group A. Removal 20 cases, not remove 51 cases, bacterial clearance rate was 28% in Group B. Difference between the two groups was statistically significant(P < 0.05).5 Mortality within 28 days: 23 cases of death, 23 cases of living, the case fatality rate of 50% in Group A. 55 cases of death, 16 cases of living, case fatality rate of 78% in Group B. Difference between the two groups was statistically significant(P < 0.05).Conclusion According to the observation of clinical curative effect, tigecycline and carbapenems antibiotics are used in the treatment of ventilator associated pneumonia caused by XDR-Ab can conclude: tigecycline used in the treatment of ventilator associated pneumonia caused by XDR-Ab have better clinical curative effect, the curative effect and prognosis of bacteriology are superior to carbapenems antibiotics. tigecycline can improve clinical cure rate and reduce the mortality rate of ventilator associated pneumonia caused by XDR-Ab.