南部某區域教學醫院Acinetobacter baumannii臨床特性與抗藥分析

Clinical Characteristics and Antimicrobial Resistance Analysis of Acinetobacter baumannii at a Teaching Hospital in Southern Taiwan

10.6526/ICJ.202408_34(4).0001

陳怡蘋(Yi-Ping Chen)；朱蓓蓓(Pei-Pei Chu)；林嘉儀(Chia-Yi Lin)；董雅玲(Ya-Ling Tung)；張簡淑贈(Shu-Tseng Chang Chien)；張科(Ko Chang)

CRAB ； CSAB ； 抗藥性 ； 菌血症 ； 死亡率 ； CRAB ； CSAB ； resistance ； bacteremia ； mortality

感染控制雜誌

34卷4期（2024 / 08 / 01）

213 - 227

繁體中文;英文

碳青黴烯類抗藥性鮑氏不動桿菌（carbapenem-resistant Acinetobacter baumannii, CRAB）為醫療照護相關感染常見的菌種，由於治療的選擇有限，經常帶給臨床極大挑戰。本研究目的為調查南部某區域教學醫院CRAB感染者臨床特徵、抗生素抗藥性、菌血症特性分析。採回溯性分析，研究期間自2018年1月至2021年12月，共373株鮑氏不動桿菌，分屬於373位住院病人，計CRAB有157名、CSAB（Carbapenem-sensitive Acinetobacter baumannii）216名。CRAB感染者人數及佔該年度鮑氏不動桿菌感染者比例：2018年37人（38.1%）、2019年42人（41.6%）、2020年35人（48.0%）和2021年43人（42.2%），CRAB比例未有逐年上升趨勢（p = 0.614）。經卡方分析發現CRAB與CSAB感染者在年齡層、檢體類別、藥物抗藥與否：包括amikacin（AN）、gentamicin（GM）、ceftazidime（CAZ）、cefepime（FEP）、cefoperazone/sulbactam（SFP）、piperacillin-tazobactam（TZP）、ampicillin/sulbactam（SAM）、trimethoprim-sulfamethoxazole（SXT）、tigecycline（TGC）、levofloxacin（LVX）具有統計上差異。多變項分析顯示鮑氏不動桿菌若具有SAM抗藥，增加CRAB感染風險17倍（95%CI = 5.9-49.3, p < 0.001）；具有SFP抗藥，CRAB感染風險增加4.9倍（95%CI = 1.2-19.5, p = 0.041）。總體而言，具有SAM與SFP抗藥提高CRAB感染發生風險。另一方面，比較菌血症CRAB與CSAB兩族群，結果顯示兩族群之多種抗生素（包括GM、CAZ、TZP、SAM、IPM和SXT）之抗藥性具有統計顯著差異；多變項分析結果發現菌血症患者若具有SAM抗藥增加，則同時發生CRAB風險達19.5倍（95%CI = 1.3-292.8, p = 0.032）。此研究有助於瞭解CRAB感染者特性及選用藥物時的參考。

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a pathogen commonly encountered in healthcare-associated infections. Clinical management poses significant challenges because of limited treatment options. This study, spanning between 2018 and 2021, aimed to investigate the clinical characteristics, antibiotic resistance patterns, and bacteremia features of patients infected with CRAB in a teaching hospital located in the southern region of Taiwan. It encompassed 373 strains of A. baumannii isolated from 373 hospitalized patients, with 157 cases classified as CRAB and 216 as carbapenem-sensitive A. baumannii (CSAB) for comparative analysis. The number of patients infected with CRAB and their proportions among A. baumannii infections were as follows: 37 (38.1%) in 2018, 42 (41.6%) in 2019, 35 (48.0%) in 2020, and 43 (42.2%) in 2021. No significant upward trend was observed in the proportion of CRAB cases over time (p = 0.614). Chi-squared analysis revealed significant differences between patients infected with CRAB and CSAB in terms of age group, specimen type, and drug resistance profiles, including amikacin (AN), gentamicin (GM), ceftazidime (CAZ), cefepime (FEP), cefoperazone/sulbactam (SFP), piperacillin-tazobactam (TZP), ampicillin/sulbactam (SAM), trimethoprim-sulfamethoxazole (SXT), tigecycline (TGC), and levofloxacin (LVX). When A. baumannii exhibited resistance to SAM, the odds ratio for CRAB infection was 17 (95% CI = 5.9-49.3, p < 0.001), and when it exhibited resistance to SFP, the odds ratio was 4.9 (95% CI =1.2-19.5, p = 0.041). Overall, resistance to SAM and SFP was associated with CRAB infection. Furthermore, chi-square analysis was performed on bacteremia cases of CRAB and CSAB, showing significant differences in the drug resistance profiles (GM, CAZ, TZP, SAM, IPM, and SXT) between the two groups. In cases of CRAB bacteremia with SAM resistance, the odds ratio for CRAB infection was 19.5 (95% CI = 1.3-292.8, p = 0.032). This study contributes to a better understanding of the characteristics of patients infected with CRAB, and provides valuable insights into drug selection.