摘要
目的探讨肠外瘘患者并发腹腔感染病原菌、耐药性及相关影响因素,并基于影响因素构建风险预测模型。方法选取2020年2月至2023年12月于本院接受治疗的肠外瘘患者121例作为研究对象,根据是否并发腹腔感染分为感染组(n=67)和非感染组(n=56),对感染组患者开展细菌分离培养,对分离获取的病原菌实施药物敏感试验;并采用Logistic回归分析影响肠外瘘患者并发腹腔感染的危险因素,并依据危险因素构建预测肠外瘘患者并发腹腔感染风险的综合指数;绘制受试者工作特征(ROC)曲线分析危险因素及综合指数预测肠外瘘患者并发腹腔感染风险的AUC值、敏感度及特异度。结果67例肠外瘘并发腹腔感染患者经病原菌培养分离出75株病原菌,其中革兰阳性菌共28株(占37.33%),革兰阴性菌共47株(占62.67%)。药敏结果显示,粪肠球菌对利福平的耐药率最高,其次为庆大霉素、环丙沙星;屎肠球菌对氨苄西林的耐药率最高,其次为环丙沙星、左氧氟沙星;大肠埃希菌对氨苄西林的耐药性最高,其次为氨苄西林/舒巴坦、头孢曲松;肺炎克雷伯菌对氨苄西林的耐药性最高,其次为氨苄西林/舒巴坦、头孢唑林。感染组与非感染组在性别、年龄、BMI、吸烟史、饮酒史、高血压、血红蛋白、术中出血量等资料差异无统计学意义(均P>0.05);而在糖尿病史、白蛋白、手术时间、抗生素使用时间等资料差异有统计学意义(均P<0.05)。Logistic回归模型分析显示,糖尿病史、白蛋白<30 g/L、手术时间≥160 min、抗生素使用时间>14 d是影响肠外瘘患者并发腹腔感染的危险因素(均P<0.05)。ROC曲线分析显示,糖尿病史、白蛋白、手术时间、抗生素使用时间及综合指数预测肠外瘘患者并发腹腔感染的AUC分别为(0.616、0.668、0.628、0.627、0.788)。结论肠外瘘患者并发腹腔感染以大肠埃希菌、肺炎克雷伯菌、粪肠球菌、屎肠球菌多见,且糖尿病史、白蛋白、手术时间、抗生素使用时间会对患者并发腹腔感染产生影响。
Objective To investigate the pathogenic bacteria,drug resistance and related influencing factors in patients with intestinal fistula complicated with abdominal infection,and build a risk prediction model based on influencing factors.Methods A total of 121 patients with intestinal fistula who received treatment in our hospital from February 2020 to December 2023 were selected as research objects,and divided into infected group(n=67)and non-infected group(n=56)according to whether they had intrabitoneal infection.Bacteria were isolated and cultured in infected group,and drug sensitivity tests were performed on isolated pathogens.Logistic regression analysis was used to analyze the risk factors of intestinal fistula patients complicated with abdominal infection,and based on the risk factors,a comprehensive index was constructed to predict the risk of intestinal fistula patients complicated with abdominal infection.Receiver operating characteristic(ROC)curve was drawn to analyze the AUC value,sensitivity and specificity of risk factors and composite index to predict the risk of abdominal infection in patients with intestinal fistula.Results 75 strains of pathogenic bacteria were isolated from 67 patients with intestinal fistula complicated with abdominal infection,of which 28 strains(37.33%)were gram-positive and 47 strains(62.67%)were gram-negative.The results showed that the resistance rate of Enterococcus faecalis to rifampicin and erythromycin was the highest,followed by gentamicin and ciprofloxacin.The resistance rate of Enterococcus faecium to ampicillin was the highest,followed by ciprofloxacin and levofloxacin.The resistance of Escherichia coli to ampicillin was the highest,followed by ampicillin/sulbactam and ceftriaxone.Klebsiella pneumoniae showed the highest resistance to ampicillin,followed by ampicillin/sulbactam and cefazolin.There were no significant differences in gender,age,BMI,smoking history,drinking history,hypertension,hemoglobin and intraoperative blood loss between the infected and non-infected groups(all P>0.05).There were significant differences in diabetes history,albumin,operation time and antibiotic use time(all P<0.05).Logistic regression model analysis showed that diabetes history,albumin<30 g/L,operation time≥160 min and antibiotic use time>14 days were risk factors for intraperitoneal infection in patients with intestinal fistula(all P<0.05).ROC curve analysis showed that the AUC of diabetes history,albumin,operation time,antibiotic use time and composite index predicting intraperitoneal infection in patients with fistula were 0.616,0.668,0.628,0.627 and 0.788.Conclusion E.coli,K.pneumoniae,E.s faecalis and E.faecium were common in patients with intestinal fistula complicated with abdominal infection,and the history of diabetes,albumin,operation time and antibiotic use time would affect the patients complicated with abdominal infection.
作者
王正冬
马钰栋
周爱明
WANG Zhengdong;MA Yudong;ZHOU Aiming(GastroenterologyDepartment,First AffiliatedHos of Kangda College,Nanjing Medical University,Lianyungang First People's Hospital,Nanjing 222000,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2024年第9期1104-1108,共5页
Journal of Pathogen Biology
基金
连云港市科技计划项目(No.SF2345)。
关键词
肠外瘘
腹腔感染
病原菌
耐药性
风险预测模型
parenteral fistula
abdominal infection
pathogenic bacteria
drug resistance
risk prediction model
