| Objective: To investigate the distribution,related risk factors and bacterial drug resistance of Acinetobacter baumannii in sterile body fluids for rational use of antimicrobial agents.Methods: The medical records of 99 children with Acinetobacter baumannii positive in sterile body fluids at the First Affiliated Hospital of Guangxi Medical University from 2012 to 2018 were retrospectively reviewed,Baseline characteristics and potential risk factors were analyzed,including: age,sex,admission ward,the presence of underlying diseases,duration of hospitalization,surgical procedure,recent invasive procedures,prior exposure to antibiotics,type of positive samples,drug susceptibility test results and other laboratory Parameters.All data were processed and analyzed by SPSS24.0 soft ware package.Measurement data was expressed by mean±standard deviation and comparison between two groups was made through grouping t test.Counting data comparison was conducted chi-square test or Fisher exact tests,with the setting = 0.05 as the test level.When the data meets p<0.05,the difference was statistically significant.Use logistic regression analysis to analyze risk factors.Results:1.Clinical distribution characteristicsAmong the 99 Acinetobacter baumannii,the separation rate of the bacteria in the Pediatric intensive care unit(PICU)is the highest,up to 68.7%(68/99).In the past 7 years,we have detected 48 strains of multi-drug resistance acinetobacter baumannii,and the composition ratio increased year by year,from38.5% to 60.0%.Its detection rate in PICU ward is also higher than other wards.Among all kinds of sterile specimens,the most common sample was lower respiratory tract specimens,including tracheal intubation tip specimens and alveolar lavage fluid,as high as 52.5%(52/99),followed by blood,accounting for 23.2%(23/99).The most common underlying disease in children with positive lower respiratory tract specimens was respiratory disease,accounting for 40.4%,while the most common underlying diseases in children with positive blood specimens were hematologic tumor diseases,accounting for 39.1%.2.Analysis of related risk factors between the multi-drug resistance group and the non-multi-drug resistance groupThe related risk factors for hospital infection of multidrug resistant acinetobacter baumannii include use of antibiotics for three or more than three kinds,mechanical ventilation,endotracheal intubation and arterial intravascular catheter.There were statistically significant differences between the multi-drug resistant(MDR)group and non-MDR group(p<0.05).Multiple factors analysis showed that the use of arterial intravascular catheter was the independent risk factor.3.Analysis of the resistance of acinetobacter baumannii to commonly used antibiotics drugsThe high rates of drug resistance to β-lactam antimicrobial agents were observed in recent 7 years at our hospital,especially the ceftazidime(65.7%).Among them,Multi-drug resistant group had higher resistance to 15 commonly used antibiotics than non-MDR group.Besides,the resistance to tegacycline was the lowest,as high as 6.3%,followed by the cefoperazone and sulbactam(58.3%).Although the drug resistance rate of Acinetobacter baumannii to cefoperazone sulbactam was relatively low in PICU as a whole,it increased in recent two years and reached the peak of 72.7% in 2017..Conclusion:1.PICU is the most serious ward for AB infection in the pediatric inpatient ward of our hospital.2.The lower respiratory tract is most infected by AB in our hospital,followed by blood.3.The related risk factors of MDRAB in departement of pediatric in our hospital include use of ≥3 antibiotics,mechanical ventilation,endotracheal intubation and arterial intravascular catheter,of which arterial intravascular catheter was the independent risk factor.4.The MDRAB strain of our hospital has weaker resistance to cefoperazone sulbactam,so cefoperazone sulbactam can be the priority option of treatment,but it should be cautiously used in PICU.5.MDRAB’s hospital infection can be reduced to some extent through Minimizing arterial intravascular catheter methods. |
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