摘要
目的探讨重症监护病房(ICU)血流感染患者病原菌分布、临床特点及影响血流感染和预后的相关危险因素。方法选择2019年1月至12月河南科技大学附属许昌市中心医院ICU收治的130例重症患者为研究对象。所有患者采用法国生物梅里埃公司Vitek2 compact型全自动细菌鉴定仪及配套GN鉴定卡检测血液中病原菌,根据病原菌检测结果和临床表现诊断是否存在血流感染。按有无血流感染将患者分为血流感染组(n=65)和无血流感染组(n=65),血流感染患者根据预后分为死亡组(n=31)和存活组(n=31)。收集患者的年龄、性别、入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHⅡ)评分、基础疾病、侵袭性操作(动脉插管、静脉插管、气管插管、引流管、导尿管及胃管等)、输血及抗菌药物使用等临床资料,分析ICU患者血流感染及死亡的危险因素。结果130例患者中发生血流感染65例,无血流感染患者65例。血流感染组患者共分离出65株病原菌,其中革兰阴性菌50株(76.92%),革兰阳性菌15株(23.08%);革兰阴性菌以大肠杆菌[36.92%(24/65)]、肺炎克雷伯菌[24.62%(16/65)]、鲍曼不动杆菌[4.62%(3/65)]为主,革兰阳性菌以凝固酶阴性葡萄球菌[6.15%(4/65)]、肺炎链球菌[6.15%(4/65)]、金黄色葡萄球菌[4.62%(3/65)]为主。单因素分析结果显示,患有泌尿系统疾病和感染前3个月内行动脉插管、静脉插管、胃管插管、应用第3代头孢菌素、应用青霉素类、应用替加环素、应用碳青霉烯类、应用碳青霉烯类+其他药物为ICU患者血流感染的危险因素(P<0.05);多因素logistic回归分析结果显示,患有泌尿系统疾病[比值比(OR)=4.127,95%置信区间(CI):1.049~16.227]和感染前3个月内行静脉插管(OR=3.639,95%CI:1.097~12.073)、应用第3代头孢菌素(OR=8.090,95%CI:2.051~31.901)、应用替加环素(OR=10.089,95%CI:1.834~55.515)、应用碳青霉烯类+其他药物(OR=7.992,95%CI:2.120~30.134)为ICU患者血流感染的独立危险因素(P<0.05)。单因素分析结果显示,患有代谢性疾病和死亡前3个月应用第3代头孢菌素、碳青霉烯类、碳青霉烯类+其他药物为ICU血流感染患者死亡的危险因素(P<0.05);多因素logistic回归分析结果显示,患有代谢性疾病(OR=4.208,95%CI:1.056~16.774)和感染前3个月内应用碳青霉烯类+其他药物(OR=20.454,95%CI:2.320~180.331)为ICU血流感染患者死亡的独立危险因素(P<0.05)。结论对于ICU患者积极治疗原发病、合理应用抗菌药物、减少有创操作,可降低血流感染的发生率及病死率。
Objective To investigate the pathogen distribution,clinical characteristics,risk factors affecting bloodstream infection and prognosis in patients with bloodstream infection in intensive care unit(ICU).Methods A total of 130 patients with critical diseases admitted to ICU of Xuchang Central Hospital Affiliated to Henan University of Science and Technology from January to December 2019 were selected as study objects.All strains were identified by Viteck2 compact automatic bacterial identification system and GN card,the presence of bloodstream infection was diagnosed according to the detection of pathogens and clinical manifestations.The 130 patients with critical diseases were divided into bloodstream infection group(n=65)and non bloodstream infection group(n=65)according to whether had bloodstream infection,and the patients with bloodstream infection were divided into death group(n=31)and survival group(n=34)according to prognosis.The clinical data including the age,gender,acute physiology and chronic health status scoring system II(APACHII),basic diseases,invasive operation(arterial intubation,venous intubation,endotracheal intubation,drainage tube,urinary catheter and gastric tube),blood transfusion and use of antibiotics were collected,and the risk factors of bloodstream infection and death of patients in ICU were analyzed.Results Among 130 patients with critical diseases,65 cases had blood flow infection and 65 cases had no blood flow infection.A total of 65 strains of pathogens were isolated from 65 patients with blood flow infection,including 50 strains of gram-negative bacteria(76.92%)and 15 strains of gram-positive bacteria(23.08%);gram-negative bacteria were mainly Escherichia coli[36.92%(24/65)],Klebsiella pneumoniae[24.62%(16/65)]and Acinetobacter baumannii[4.62%(3/65)];gram-positive bacteria were mainly coagulasen negative Staphylococcus[6.15%(4/65)],Streptococcus pneumoniae[6.15%(4/65)]and Staphylococcus aureus[4.62%(3/65)].Univariate analysis results showed that urinary diseases and arterial intubation,venous intubation,gastric intubation,application of the third-generation cephalosporins,application of penicillins,application of tegacyclin,application of carbapenems,application of carbapenems plus other drugs within 3 months before infection were the risk factors for bloodstream infection of patients in ICU(P<0.05).Multivariate logistic regression analysis showed that urinary diseases[odds ratio(OR)=4.127,95%confidence interval(CI):1.049-16.227]and intravenous intubation(OR=3.639,95%CI:1.097-12.073),use of the third-generation cephalosporins(OR=8.090,95%CI:2.051-31.901),tegacycline(OR=10.089,95%CI:1.834-55.515),carbapenem plus other drugs(OR=7.992,95%CI:2.120-30.134)within 3 months before infection were the independent risk factor for bloodstream infection of patients in ICU(P<0.05).Univariate analysis showed that the use of the third-generation cephalosporins,carbapenems,carbapenems plus other drugs within 3 months before death and metabolic diseases were the risk factors for death of patients with bloodstream infection in ICU(P<0.05).Multivariate logistic regression analysis showed that the use of carbapenem plus other drugs(OR=20.454,95%CI:2.320-180.331)within 3 months before death of patients and metabolic disease(OR=4.208,95%CI:1.056-16.774)were the independent risk factor for death of patients with bloodstream infection in ICU.Conclusion For ICU patients,active treatment of primary diseases,rational application of antibiotics and reduction of invasive operation can reduce the incidence and mortality of blood stream infection.
作者
陈国芹
刘丹
吕水林
郭坤山
刘艳霞
CHEN Guoqin;LIU Dan;LYU Shuilin;GUO Kunshan;LIU Yanxia(Clinical Medicine Discipline,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuchang 461000,Henan Province,China;Department of Education,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuehang 461000,Henan Province,China;Department of Urology Surgery,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuchang 461000,Henan Province,China;Laboratory Division,Xuchang Central Hospital Ajfiliated to Henan University of Science and Technology,Xuchang 461000,Hermn Province,China;Xuchang Centre for Food and Drug Control Chinese Medicine Room,Xuchang 461000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2022年第1期45-50,共6页
Journal of Xinxiang Medical University
关键词
重症监护病房
血流感染
危险因素
预后
intensive care unit
bloodstream infection
risk factors
prognosis
