摘要
目的:分析广泛耐药鲍曼不动杆菌(extensively drug-resistant Acinetobacter baumannii,XDR-AB)肺部感染患者疾病转归的影响因素,并构建Logistic回归预测模型,为临床及早预测制定防治措施提供参考。方法:选取2017年2月—2020年12月平煤神马医疗集团总医院收治的120例XDR-AB肺部感染患者作为研究对象,采集患者的性别、年龄、诊断、并发症、住院时间、用药情况、检查指标、转归情况等信息,分析患者疾病转归的影响因素,并构建Logistic回归预测模型。结果:120例XDR-AB肺部感染患者中,治疗后存活68例(占56.67%)、病死52例(占43.33%);单因素分析结果显示,存活组患者入住ICU率、合并心功能不全率、合并呼吸衰竭率、联用抗真菌药物率、抗菌药物使用时间<6 d率、使用无创呼吸机率、有创通气率、留置胃管率、感染时最高体温<38.6℃均低于病死组(P<0.05);多因素分析结果显示,XDR-AB肺部感染与患者伴有心功能不全、联用抗真菌药物、有创通气间具有密切相关性(P<0.05),均为导致患者XDR-AB感染的危险因素(P<0.05);抗菌药物使用时间<6 d为其保护因素(P<0.05);似然比(χ^(2)、Waldχ^(2))检验表明模型的构建有效;Hosmer-Lemeshow拟合优度检验表明模型拟合效果较好。结论:影响XDR-AB肺部感染患者疾病转归的影响因素诸多,患者伴有心功能不全、联合使用抗真菌药物、有创机械通气是导致XDR-AB感染的独立危险因素,而抗菌药物使用时间<6 d为其保护因素,构建Logis‐tic回归预测模型对XDR-AB肺部感染患者疾病转归具有良好的预测价值。
Objective:To analyze the influencing factors of disease outcome in patients with extensively drug�resistant Acinetobacter baumannii(XDR-AB)pulmonary infection,and construct a Logistic regression prediction model,so as to provide reference for early prediction and development of prevention measures in clinical practices.Methods:A total of 120 patients with XDR-AB pulmonary infection admitted to the hospital from February 2017 to December 2020 were selected as the research objects.Information of patients such as gender,age,diagnosis,complication,length of stay,medication,examination index,and outcome were collected,the influencing factors of disease outcome were analyzed and a Logistic regression prediction model was constructed.Results:Among 120 patients with XDR-AB pulmonary infection,68 survived(56.67%)and 52 died(43.33%)after treatment.Univariate analysis showed that the rate of admission to ICU,rate of combined cardiac insufficiency,rate of combined respiratory failure,rate of combined use of antifungal drugs,rate of use of antibacterial drugs for less than 6 days,rate of use of noninvasive ventilator,rate of invasive ventilation,rate of indwelling gastric tube and rate of the highest body temperature(below 38.6℃)at the time of infection in the survival group were lower than those in the death group(P<0.05).Multivariate analysis showed that XDR-AB pulmonary infection was closely related to cardiac insufficiency,combined use of antifungal drugs and invasive ventilation of patients(P<0.05),all of which were risk factors for XDR-AB infection(P<0.05).The use of antibacterial drugs for less than 6 days was a protective factor(P<0.05).The likelihood ratio(χ^(2),Waldχ^(2))test indicated that the model constructed was effective.The test of Hosmer-Lemeshow goodness of fit indicated a good fitting effect of the model.Conclusion:There are many influencing factors of disease outcome in patients with XDR-AB pulmonary infection.Patients with cardiac insufficiency,combined use of antifungal drugs and invasive mechanical ventilation are independent risk factors for XDR-AB infection,while the use of antibacterial drugs for less than 6 days is a protective factor.The Logistic regression prediction model has good predictive value for disease outcome in patients with XDR-AB pulmonary infection.
作者
郑院青
李雪
张倩
ZHENG Yuan-qing;LI Xue;ZHANG Qian(General Hospital of Pingmei Shenma Group,Pingdingshan Henan 467000,China)
出处
《抗感染药学》
2023年第3期277-281,共5页
Anti-infection Pharmacy
关键词
广泛耐药鲍曼不动杆菌
肺部感染
疾病转归
影响因素
extensively drug-resistant Acinetobacter baumannii
pulmonary infection
disease outcome
influencing factor
