鲍曼不动杆菌医院感染的危险因素及预测模型研究

The nosocomial infection especially caused by antibiotic resistant bacteria is a severe public health problem nowadays or in the coming future. The prevention of nosocomial infection is more important than the treatment while the antibiotic resistant bacteria becoming the key pathogen of health care associated infection. The target based surveillance studies on the prevention and control of nosocomial infection are relatively backward in China. Most of the evidence-based data were incited from studies held in some developed countries. Acinetobacter baumanii is the worldwide spread pathogen induced the health care associated infection. The multiple drug resistant or even pan-resistant A. baumanii were much more commonly detected in the nosocomial infection patients than before. So we pay more attention to the strategy study on the prevention and control of infections caused by A. baumanii. According to the studies on single risk factor or a few risk factors held by different groups, combined with the suggestive advice provided by nosocomial infection management committee, we figured out the possible influence factors of nosocomial infection.By comprehensively analyzing the multiple risk factors related to nosocomial infection cases found between 2009 and 2012 in our hospital which is the biggest hospital in Zhejiang province, the risk factors are statistically explored and cleared out by Delphi method. The predictive model for the patients in high risk of nosocomial infection caused by A. Baumanii is constructed by using logistic regression analysis model. This model also will be verified by prospective study. The early warning of patients at high risk of nosocomial infection is helpful for the intervention against the sporadic cases according to rule of the evidence-based medicine. The outbreak of nosocomial infection caused by A baumanii will be reduced hopefully. Based on the early warning of the sporadic infection, we induct the predictive model into the nosocomial infection management software and evaluate its practicability, so as to promote evidence-based hospital infection prevention and control. The results of this research is also supposed to be advisable for the controlling of health care associated infection caused by the pathogens hard to be treated.

医院感染尤其是耐药菌相关的感染已经成为重要的公共卫生问题。近年来鲍曼不动杆菌已经跃升为主要医院感染致病菌，多重耐药和泛耐药鲍曼不动杆菌的涌现常常使抗菌药物束手无策，如何预防已成为控制医院感染的关键。我国基于目标性监测的医院感染防控研究相对落后。本课题组立足鲍曼不动杆菌的医院感染问题，拟通过对医院整体医疗环境的监测，综合多因素分析，利用logistic回归分析模型结合Delphi专家咨询法探讨可能的危险因素，构建鲍曼不动杆菌医院感染高危患者的预测模型。本研究将预警节点提前，通过对高危患者的主动干预以减少散发病例发生，医院感染发生率及暴发流行有望得到控制。本课题将预测模型与现有的医院感染管理软件系统相结合，研究成果可迅速应用于实践并得到验证；并将从预防医学角度为鲍曼不动杆菌医院感染的防控提出新策略，也可为防控其他病原菌尤其是难治性病原菌引发的医院感染提供有益借鉴。

鲍曼不动杆菌是重要的医院感染病原菌，临床中在面对多重耐药和泛耐药鲍曼不动杆菌时较多地关注了感染后治疗以及针对细菌耐药的抗菌药物联合治疗方案的优化。然而，鲍曼不动杆菌医院感染的问题并未得到解决，而艰难梭菌、碳青霉烯类耐药肺炎克雷伯菌等医院感染问题不断涌现。因此，有必要将防控关口前移，从预防的角度探讨医院感染的防控策略和措施。本课题组立足鲍曼不动杆菌的医院感染问题，开展流行病学特征研究，明确了患者因素和环境因素对鲍曼不动杆菌医院感染的影响，比较不同部位鲍曼不动杆菌检出的临床意义以及感染风险，尤其是碳青霉烯耐药鲍曼不动杆菌血流感染对患者预后的严重不利影响；明确了鲍曼不动杆菌和艰难梭菌医院感染特点的异同，提出了针对不同病原菌以及同一种病原菌不同部位感染应采用不同的防控策略和措施；运用针对鲍曼不动杆菌的多维度感染防控措施，课题组在H7N9禽流感的救治中取得了明显的效果，通过医院感染防控，有效降低了引起社会恐慌的禽流感的病死率。本研究单位5%的人感染H7N9病死率（同期全国平均水平超过40%），结果具有明显的科学意义和社会价值。