|
| 重症监护病房多重耐药ESKAPE-E病原体血流感染临床特征及死亡影响因素分析 |
| Analysis of clinical features and risk factors for death of multi-drug resistant ESKAPE-E pathogen bloodstream infection in in- tensive care unit |
| 投稿时间：2022-11-23 |
| DOI：10.3969/j.issn.1000-0399.2023.06.007 |
| 中文关键词: 重症监护病房 ESKAPE-E 血流感染 临床特征 危险因素 |
| 英文关键词: Intensive care unit ESKAPE-E Bloodstream infection Clinical characteristics Risk factors |
| 基金项目:蚌埠市科技创新指导类项目（编号：20200301） |
|
| 摘要点击次数: 786 |
| 全文下载次数: 251 |
| 中文摘要: |
| 目的 探索多重耐药ESKAPE-E病原体血流感染危险因素和死亡风险。方法 回顾性分析2019年1月至2022年12月蚌埠市第一人民医院重症监护病房收治的61例ESKAPE-E血流感染患者的临床资料。分析61例患者血培养ESKAPE-E病原体菌株和耐药机制的分布以及主要检出菌的耐药率。依据患者血培养ESKAPE-E病原体是否存在多重耐药分为多重耐药组(35例)和非多重耐药组(26例),应用单因素分析比较两组患者的临床资料,筛选有意义的变量纳入多因素logistic回归,分析多重耐药ESKAPE-E血流感染的独立危险因素,并且采用Kaplan-Meier生存曲线比较两组患者的累积死亡风险;根据患者住院期间的临床结局分为死亡组(23例)和存活组(38例),运用单因素分析和Cox风险回归,探讨死亡患者的独立危险因素。结果 61例患者共检出革兰阴性杆菌感染51例,主要检出菌为大肠杆菌和肺炎克雷伯菌,对三、四代头孢(28.0%~56.0%)和喹诺酮类(48.0%~63.6%)呈现了较高的耐药率,头孢哌酮/舒巴坦和头孢西丁耐药率较低(<20.0%),肺炎克雷伯菌对碳青霉烯的耐药率达到了30.8%;多因素logistic回归显示≥ 3种合并症(OR=4.894;95% CI:1.394~17.177)、不合理的经验性抗生素治疗(OR=3.843;95% CI:1.065~13.857)是患者多重耐药ESKAPE-E血流感染的独立危险因素。Kaplan-Meier生存曲线显示与非多重耐药组相比,多重耐药组患者住院期间具有更高的死亡风险(χ2=5.928,P<0.05);Cox风险回归显示休克(HR=3.523;95% CI:1.024~12.115)、气管插管(HR=4.341;95% CI:1.636~11.519)、不合理的经验性抗生素治疗(HR=3.823;95% CI:1.091~13.396)是ESKAPE-E血流感染患者住院期间的独立死亡因素。结论 重症监护病房患者ESKAPE-E血流感染多重耐药风险高,≥ 3个合并症和不合理的经验性抗生素治疗是多重耐药ESKAPE-E血流感染的独立危险因素,休克、气管插管和不合理的经验性抗生素治疗是ESKAPE-E血流感染患者住院期间死亡的独立危险因素。 |
| 英文摘要: |
| Objective To explore the risk factors and mortality risk of multi-drug resistant ESKAPE-E pathogens bloodstream infection. Methods A retrospective analysis was performed on the clinical data of 61 patients with ESKAPE-E bloodstream infections admitted to the Intensive Care Unit of the First People’s Hospital of Bengbu from January 2019 to December 2022. The distribution of strains and resistance mechanisms of ESKAPE-E pathogens in blood cultures of 61 patients and the resistance rates of major detected bacteria were analyzed. The patients were divided into multi-drug resistant group (35 patients) and non-multi-drug resistant group (26 patients) according to the presence of multi-drug resistant ESKAPE-E pathogens in blood culture, and the clinical data of the two groups were compared using univariate analysis. Kaplan-Meier survival curves were used to compare the cumulative risk of death in the two groups. The patients were divided into a death group (23 patients) and a survival group (38 patients) according to their clinical outcomes during hospitalization. Univariate analysis and Cox regression were used to explore the independent risk factors of patients who died. Results A total of 51 Gram-negative bacilli were detected in 61 patients, with Escherichia coli and Klebsiella pneumoniae in the top two positions. The main detected bacteria, E. coli and Klebsiella pneumoniae, showed high resistance rates to third-and fourth-generation cephalosporins (28.0%~56.0%) and quinolones (48.0%~63.6%), while cefoperazone/sulbactam and cefoxitin showed lower resistance rates (<20.0%), and Klebsiella pneumoniae showed 30.8% resistance rate to carbapenems. Multifactorial logistic regression showed that ≥3 comorbidities (OR=4.894; 95%CI:1.394~17.177), and unreasonable empirical antibiotic therapy (OR=3.843; 95%CI:1.065~13.857) were independent risk factors for multi-resistant ESKAPE-E bloodstream infection in patients. Kaplan-Meier survival curves showed that patients in the multi-drug resistant group had a higher risk of death during hospitalization compared with those in the non-multi-drug resistant group (χ2=5.928, P<0.05). Cox regression showed that shock (HR=3.523; 95%CI:1.024~ 12.115), tracheal intubation (HR=4.341; 95%CI:1.636~11.519), unreasonable empirical antibiotic therapy (HR= 3.823; 95% CI:1.091~13.396) were independent factors of death during hospitalization in patients with ESKAPE-E bloodstream infection.Conclusion Patients in the intensive care unit are at high risk of multi-drug resistant ESKAPE-E bloodstream infections. ≥3 comorbidities and unreasonable empirical antibiotic therapy are independent risk factors for multi-drug resistant ESKAPE-E bloodstream infections, and shock, tracheal intubation and unreasonable empirical antibiotic therapy are independent risk factors for death during hospitalization in patients with ESKAPE-E bloodstream infections. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
