Drug resistance monitoring of Acinetobacter baumannii and its influencing factors

Luan Jingjing; Fang Hui; Sun Xufang

doi:10.3969/j.issn.1672-8157.2025.04.035

Abstract：Objective To analyze drug resistance of Acinetobacter baumannii(AB)and its influencing factors to provide clinical basis for rational use of antibiotics.Methods A retrospective analysis was performed on the clinical data of patients with positive AB culture in different departments of Sunshine Union Hospital between January 2021 and December 2023.The changes of AB resistance were determined.The main influencing factors of AB resistance were analyzed by univariate and multivariate logistic analysis.Results There were 424 strains of AB isolated after remove duplicates,including 281 common strains(66.27% )and 143 drug-resistant strains(33.73% ).From 2021 to 2023,AB strains were mainly from sputum/bronchoalveolar lavage fluid(89.51% ),urine(3.50% )and secretion(2.80% ).From 2021 to 2023,AB strains were mainly from ICU(69 strains(48.25% )),medical care center(25 strains(17.48% ))and neurosurgery department(17 strains(11.89% )).There was different degrees of resistance to 12 kinds of commonly used antibiotics in patients with AB infection,3-year average drug resistance rates to 10 kinds were all≥30%,and 3-year average drug resistance rates to minocycline and cefoperazone/sulbactam were the lowest(15.57%,21.70% ).The uni-variate analysis showed that there were significant differences in age,length of hospital stay,stay time in ICU,score of acute phys-iology and chronic health evaluation(APACHE)Ⅱ≥15 points,diabetes mellitus,tracheotomy,use of carbapenem,combined use of antibiotics,use time of antibiotics and use of immunosuppressant/hormone between the two groups(χ2=8.267,4.052,17.391,31.506,10.530,38.624,8.008,4.482,15.810,39.541,all P<0.05).Binary Logistic regression analysis showed that age≥60 years(OR=2.153,95% CI(1.093,4.243),P=0.027),diabetes mellitus(OR=2.134,95% CI(1.068,4.263),P=0.032),stay time in ICU(OR=1.980,95% CI(1.141,3.434),P=0.015),length of hospital stay≥14 d(OR=2.186,95% CI(1.036,4.631),P=0.042),APACHEⅡ≥15 points(OR=2.149,95% CI(1.164,3.969),P=0.015),tracheotomy(OR=2.004,95% CI(1.023,3.925),P=0.043),use of carbapenem antibiotics(OR=1.972,95% CI(1.019,3.817),P=0.045),types of used antibiotics>3(OR=2.197,95% CI(1.091,4.423),P=0.028),antibiotics use time≥1 week(OR=4.007,95% CI(1.929,8.323),P<0.001)and use of immunosuppressant/hormone(OR=2.143,95% CI(1.081,4.246),P=0.030)were all independent risk factors of AB resistance(P<0.05).Conclusion Multi-drug resistance of AB is more serious in ICU,medical care center and neurosurgery department of the hospital.For patients with advanced age,diabetes mellitus,tracheotomy,use of immunosuppressant/hormone,long length of hospital stay and stay time in ICU and respira-tory/urinary tract infection,it is necessary to strengthen real-time monitoring of bacterial resistance and pay attention to standardized use of carbapenems,and adjuvant therapy with minocycline and tigacycline should be taken when necessary.