Acinetobacter Baumannii Bloodstream Infection: Clinical Features and Antimicrobial Susceptibilities of Isolates

Acinetobacter Baumannii引起菌血症之臨床特徵與抗生素感受性

賴世偉(Shih-Wei Lai) ； 黃金財(Kim-Choy Ng) ； 余文良(Wen-Liang Yu) ； 劉秋松(Chiu-Shong Liu) ； 賴明美(Ming-May Lai) ； 林正介(Cheng-Chieh Lin)

《The Kaohsiung Journal of Medical Sciences》 15卷7期 (1999/07) Pp. 406-413

https://doi.org/10.6452/KJMS.199907.0406

摘要

Acinetobacter baumannii所引起的院內感染逐年增加。為了明瞭A. baumannii 引起菌血症的危險因子，從1996年1月到1997年12月，我們對36個因A. baumannii引起菌血症之病例做了回性的研究。結果顯示，所有病例均屬於院內感染，其中男性23人，女性13人。有一例是因留置動脈導管而引起菌血症，有三例是因感染A. baumannii而引起肺炎。21例（58％）雖有留置中央靜脈導管，但未能證實與感染有關。32例（89％）其傳染途徑仍不明。多變項邏輯迴規分析顯示先前使用抗生素是引起A. baumannii菌血症的危險因子。A. baumannii引起菌血症最常見的臨床症依次為發燒，白血球增加，血小板降低與低血壓。有11例（30.6％）直接死於因A. baumannii引起的菌血症。所有的菌種均對Ampicillin，Cephalothin，Cefonicid and Moxalactam有抗藥性，對於Imipenem的抗藥性高達19％。由我們的研究顯示，A. baumannii所引起的菌血症大多數為院內感染，傳染途徑不明，且具多重抗藥性。我們建議治療A.baumannii菌血症的首選藥物為gentamicin, amikacin or ceftazidime。

並列摘要

The number of nosocomial infections caused by Acinetobacter baumannii has increased in recent years. The purposes of this study are to discover the risk factors of transmission to prevent the nosocomial infection of A. baumannii. We retrospectively studied 36 patients with A. baumannii bacteremia at China Medical College Hospital from January 1996 to December 1997. There were 23 males and 13 females. All bacteremia were acquired nosocomially. Malignancy (n=8) and intracranial hemorrhage (n=6) were the most common underlying diseases. Only one patient on arterial line disclosed intraaterial catheter-related A. baumannii bacteremia and 3 patients had evidence of A. baumannii pneumonia. Twenty-one patients (58%) had central venous catheters in place at the onset of bacteremia, but none was proven to be catheter-related infection. There were 32 patients (89%) with unknown portal of entry. Multivariate logistic regression analysis revealed that potential risk factors related to A. baumannii bacteremia were proior antimicrobial therapy (P＜0.05). The most common clinical features of A. baumannii bacteremia were, in descending order, fever, leukocytosis, thrombocytopenia and hypotension. Eleven patients (30.6%) died directly from A. baumannii bacteremia. All isolates were resistant to amplicillin, cephalothin, cefonicid and moxalactam. The most alarming evidence was that 19% of isolates showed resistance to imipenem. Our findings emphysized that A. baumannii bacteremia had the following characteristics: usually acquired nosocomially, unknown portal of entry, and high multiresistance, especially the increasing resistance rate to imipenim. Imipenem must be reserved as a last-line agent to treat A. baumannii infections, so we want to suggest that the treatment of choice for A. baumannii is gentamicin, amikacin or ceftazidime.

並列關鍵字

Acinetobacter baumannii ； nosocomial infection ； resistance