Objective To investigate the drug resistance and risk factors of hospital-acquired pneumonia (HAP) induced by imipenem-resistant Acinetobacter baumannii.Methods Clinical data on 114 patients with Acinetobacter baumannii-related HAPs admitted in Wujiang First People' s Hospital in Suzhou during January 2013 and December 2014 were retrospectively analyzed.According to the results of drug sensitivity test,patients were divided into imipenem-resistant group and non imipenem-resistant group.Drug resistance to 20 commonly used antibiotics was observed in two groups,and multivariate Logistic regression analysis was performed to identify the risk factors of imipenem-resistant Acinetobacter baumannii infection.Results Among 114 strains ofAcinetobacter baumannii,66 strains (57.89％) were imipenem-resistant and 48 strains (42.11％) were non-imipenem-resistant.The resistance rates to β-lactams,quinolones and aminoglycosides were significantly higher in imipenem-resistant group than those in non-imipenem-resistant group (P ＜ 0.01),and no tigecycline-resistant strain was found in both groups.Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥ 15,plasma level of albumin ≤ 25 g/L,intensive care unit (ICU) stay,indwelling gastric tube,deep venous catheterization,establishment of artificial airway,mechanical ventilation time ≥ 7 d,use of broad-spectrum antibiotics ≥ 14 d and combined use of antibiotics were risk factors of imipenem-resistant Acinetobacter baumannii related HAP (x2 =13.06,6.86,25.40,15.09,17.87,21.46,17.94,6.91 and 10.10,P ＜0.01).Multivariate Logistic regression analysis revealed that establishment of artificial airway [OR =72.014,95％ confidetial interval (CI):19.566-265.061,P ＜ 0.01],and use of broad-spectrum antibiotics ≥ 14 d (OR =3.892,95％ CI:1.092-13.879,P ＜ 0.05) were independent risk factors of imipenem-resistant Acinetobacter baumannii related HAP.Conclusion Imipenem-resistant Acinetobacter baumannii strains are highly resistant to most antibiotics.Strict control of invasive procedures and long-term combined use of antibiotics may reduce the occurrence of imipenem-resistant Acinetobacter baumannii related HAPs.

Objective To investigate the relationship between serum matrix metalloproteinase-13(MMP-13)and vashohibin-1(VASH-1)levels and death within 28 days after admission in patients with sepsis complicated with acute kidney injury(AKI).Methods A total of 120 patients with sepsis complicated with AKI(the AKI group)and 117 patients with simple sepsis without complicated AKI(the non-AKI group)were selected,and 136 healthy subjects during the same period were selected as the control group.Basic data of all subjects were collected,and renal function was detected.Serum MMP-13 and VASH-1 levels were detected by enzyme-linked immunosorbent assay.The survival of patients with sepsis complicated with AKI within 28 days after admission was observed.Patients were divided into the survival group(83 cases)and the death group(37 cases).The basic information,renal function,serum MMP-13 and VASH-1 levels were compared between patients in the control group,the non-AKI group,the AKI group and patients in the AKI group with different prognosis.The correlation between serum MMP-13 and VASH-1 levels in patients with sepsis complicated with AKI was analyzed by Pearson method.Logistic regression analysis was used to analyze the factors affecting the death of patients with sepsis complicated with AKI within 28 days after admission.The predictive value of serum MMP-13 and VASH-1 to death within 28 days after admission in patients with sepsis complicated with AKI was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non-AKI group,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score and sequential organ failure assessment(SOFA)score were significantly increased in the AKI group(P＜0.05).Compared with the control group and the non-AKI group,serum creatinine(Scr)and blood urea nitrogen(BUN)levels were significantly increased in the AKI group(P＜0.05).Compared with the control group,serum levels of MMP-13 and VASH-1 were increased successively in the non-AKI group and the AKI group(P＜0.05).Serum MMP-13 and VASH-1 levels were positively correlated with sepsis patients complicated with AKI(r=0.650,P＜0.05).Compared with the survival group,APACHE Ⅱscore,SOFA score,serum Scr,BUN,MMP-13 and VASH-1 levels were significantly increased in the death group(P＜0.05).APACHE Ⅱ score,serum MMP-13 and VASH-1 levels were independent risk factors for the death in patients with sepsis complicated with AKI within 28 days after admission(P＜0.05).The area under curve(AUC)of serum MMP-13,VASH-1 and their combination predict mortality within 28 days after admission in sepsis patients with AKI were 0.810,0.837 and 0.903,respectively.The AUC predicted by the combination of MMP-13 and VASH-1 was significantly higher than that predicted by serum MMP-13 and VASH-1 alone(P＜0.05).Conclusion Serum MMP-13 and VASH-1 levels are increased in patients with sepsis complicated with AKI,which could affect the prognosis of sepsis patients complicated with AKI,and have a high predictive value for death within 28 days after admission.