| ObjectiveAcinetobacter isolated from a third-class hospital in Inner Mongolia Autonomous Region from 2018 to 2020 was studied on the source of samples,patient information,drug resistance changes,clone correlation,etc.,to understand the epidemic characteristics,drug resistance and homology results of Acinetobacter baumannii in our hospital,to explore the risk factors of Acinetobacter baumannii infection and to build a risk prediction model,which can provide the basis for rational use of drugs and prevention of Acinetobacter baumannii infection.MethodObjective to analyze the clinical distribution and drug resistance of 437 patients with Acinetobacter baumannii isolated from various clinical specimens in a tertiary hospital of Inner Mongolia Autonomous Region from January 2018 to December 2020;The homology of 43 strains of bacteria and 16 strains of environmental strain from June2020 to September was analyzed by pulsed field gel electrophoresis(PFGE,pulsed Field Gel Electrophoresis).The clinical data of 307 patients with clinically isolated Acinetobacter baumannii in our hospital from January 2018 to December 2019 were collected.According to the classification of multi drug resistant Acinetobacter baumannii group and non multi drug resistant Acinetobacter baumannii group,the data were analyzed by SPSS 24.0 software,which was divided into single factor analysis and multi factor analysis logistic regression.The χ~2 test or χ~2 trend test was used for the comparison among the counting data groups,and Fisher exact probability was used for those which did not meet the requirements Objective to screen out the independent risk factors of multidrug-resistant Acinetobacter baumannii infection,to construct the risk prediction model,and to verify the model with 130 cases of Acinetobacter baumannii isolated in our hospital from January to December 2020.Result1.The rate of isolation of Acinetobacter baumannii in clinical isolates is declining year by year from 2018 to 2020.From January 2018 to December 2020,there were3245 clinical isolates from a third class hospital in Inner Mongolia Autonomous Region,2366 cases of Gram-negative bacteria,accounting for 72.91%;838 cases of Gram-positive bacteria accounted for 25.82%.Among them,831 Gram-negative bacteria were isolated in clinical practice in 2018,of which 173 strains were Acinetobacter baumannii,accounting for 15.70% of all isolates;717 Gram-negative bacteria were clinically isolated in 2019,of which 134 were Acinetobacter baumannii,accounting for 13.54% of all isolates;818 Gram-negative bacteria were isolated in 2020,of which 130 Acinetobacter baumannii accounted for 11.2 of all isolates 7%。2.According to the detection of Acinetobacter baumannii in the past three years,sputum samples had the highest constituent ratio,and ICU had the highest constituent ratio.From 2018 to 2020,437 strains of Acinetobacter baumannii were isolated in our hospital,305 strains of which were from sputum samples(69.79%).In the three years,sputum samples accounted for the first place,accounting for 67.63%,73.13% and68.46% respectively;ICU is the Department with the highest proportion of clinical detection of Acinetobacter baumannii in our hospital.The constituent ratios of Acinetobacter baumannii from 2018 to 2020 were 55.81%,60.45% and 62.31%respectively,and the proportion increased year by year(χ~2= 9.948,P = 0.007).3.The results of AB bacteria susceptibility isolated in hospitals from 2018 to 2020 showed that ab bacteria were not sensitive to penicillin,cephalosporins,carbapenems and other antimicrobial agents,and the drug resistance rate was over 80%,but it was highly sensitive to minocycline and tegacyclin,and the sensitivity rate was over 60%.Among them,AB was the most sensitive to tegacyclin,and the sensitivity rate reached79.76%,85.82% and 80.76% in three years.4.59 strains were composed of 43 patients and 16 hospital environment samples.All the strains were divided into 10 clusters(A-J),and D cluster included 18 strains at most,which were divided into D1 and D2 clone types;all the strains were divided into22 clone strains,among which 12 strains were widely distributed,including sputum(5),secretion(1),middle urine(2),medical staff(2),and the surface of the bed tail(1 strain),The surface of bedside cabinet(1 strain);all the test strains were divided into 54 different types,and the similarity between all maps was 46.16% to 100%.5.Univariate analysis showed that age ≥ 60 years old,total length of stay ≥ 30 days,operation during hospitalization,respiratory diseases,ICU admission,urinary catheterization,combined use of antibiotics were associated with hospital infection of multidrug-resistant Acinetobacter baumannii(MDR-AB),and the difference was statistically significant(P < 0.05);Multivariate logistic regression analysis showed that hospital stay ≥ 30 days(P = 0.002,or = 2.315),ICU stay(P < 0.001,or = 2.559),respiratory diseases(P = 0.002,or = 2.436)and combination of antibiotics(P < 0.001,or = 4.289)were independent risk factors for multidrug-resistant Acinetobacter baumannii infection,According to the regression coefficient,the risk prediction model of MDR AB infection was established as logistic(P)= C1 × 0.839+C2 × 0.890+C3× 0.939+C4 × 0.972-0.852;The results of Hosmer & lemeshow goodness of fit test showed that chi square = 12.786,P = 0.681 > 0.05,the fitting degree of the model was good,and the area under the ROC curve(AUC)of the validation group was 0.824,indicating that the overall prediction accuracy of the model was good,which has certain clinical significance.ConclusionFrom January 2018 to December 2020,Acinetobacter baumannii ranked second in the total proportion of clinically isolated pathogens,but the isolation rate of Acinetobacter baumannii showed a downward trend year by year.The detection rate of Acinetobacter baumannii in sputum is the highest among all clinical samples,so we should pay more attention to respiratory tract infection.In the past three years,Acinetobacter baumannii has a severe situation of resistance to commonly used drugs.When using minocycline as empirical drug,we should also pay attention to the intermittent use of antibiotics to minimize the new acquired resistance of Acinetobacter baumannii.Hospital stay ≥ 30 days,admission to ICU,hypertension,combined use of antibiotics are independent risk factors of multidrug-resistant Acinetobacter baumannii infection.Active intervention measures should be taken in many aspects to effectively reduce the infection rate by establishing infection prediction model. |
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