机械通气患者泛耐药鲍曼不动杆菌定植与感染的危险因素分析
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摘要
目的探讨ICU机械通气患者下呼吸道泛耐药鲍曼不动杆菌(XDRAB)感染与定植的危险因素。方法回顾性收集2017年1月-2018年1月某院综合ICU收治的机械通气患者的临床资料,采用多因素Logistic回归模型和ROC曲线分析其危险因素。结果纳入下呼吸道XDRAB感染与定植患者161例,单因素分析与非XDRAB感染/定植组相比,吸烟史、手术史、ICU住院时间、机械通气时间、恶性肿瘤、糖尿病、使用广谱抗菌药物> 7 d、抗菌药物联用、使用糖皮质激素、雾化治疗、合并真菌定植、气管切开差异有统计学意义(P <0. 05)。多因素Logistic回归分析,糖尿病、使用广谱抗菌药物> 7 d、抗菌药物联用、使用糖皮质激素、气管切开是机械通气患者下呼吸道XDRAB感染和定植的独立危险因素; ROC曲线下面积(AUC值)分别为0. 580、0. 649、0. 740、0. 572、0. 615。结论机械通气患者下呼吸道XDRAB感染/定植与糖尿病、使用广谱抗菌药物> 7 d、抗菌药物联用、使用糖皮质激素、气管切开密切相关,抗菌药物联用较其他危险因素有较好的预测价值,可为临床感染防控决策的制定提供指导意义。
Objective To investigate the risk factors of extensive drug-resistant Acinetobacter baumannii( XDRAB) infection and colonization in lower respiratory tract of patients with mechanical ventilation in ICU. Methods Clinical data of patients with mechanical ventilation in ICU from January 2017 to January 2018 were retrospectively invesgated. Multivariate Logistic regression model and ROC curve were used to analyze the risk factors. Results 161 cases of XDRAB infection and colonization in lower respiratory tract,Compared with non-XDRAB infection,univariate analysis showed that the differences were statistically significant in smoking history,operation history,ICU hospitalization time,mechanical ventilation time,malignant tumors,diabetes mellitus,use of broad-spectrum antibiotics for > 7 days,combination of antibiotics,use of glucocorticoids,aerosol therapy,fungal colonization and tracheotomy( P < 0. 05). Multivariate Logistic regression analysis showed that diabetes mellitus,use of broad-spectrum antibiotics for > 7 days,combination of antibiotic,use of glucocorticoid,tracheotomy were independent risk factors for XDRAB infection and colonization in patients with mechanical ventilation,and the area under the ROC curve( AUC value) was 0. 580,0. 649,0. 740,0. 572,0. 615,respectively. Conclusion XDRAB infection/colonization of lower respiratory tract in patients with mechanical ventilation is closely related to diabetes mellitus,use of broad-spectrum antibiotics for > 7 days,combination of antibiotics,use of glucocorticoid,and tracheotomy.The combination of antibiotics has better predictive value of infection than other risk factors. We provide guidance for the formulation of clinical infection prevention and control decisions.
Objective To investigate the risk factors of extensive drug-resistant Acinetobacter baumannii( XDRAB) infection and colonization in lower respiratory tract of patients with mechanical ventilation in ICU. Methods Clinical data of patients with mechanical ventilation in ICU from January 2017 to January 2018 were retrospectively invesgated. Multivariate Logistic regression model and ROC curve were used to analyze the risk factors. Results 161 cases of XDRAB infection and colonization in lower respiratory tract,Compared with non-XDRAB infection,univariate analysis showed that the differences were statistically significant in smoking history,operation history,ICU hospitalization time,mechanical ventilation time,malignant tumors,diabetes mellitus,use of broad-spectrum antibiotics for > 7 days,combination of antibiotics,use of glucocorticoids,aerosol therapy,fungal colonization and tracheotomy( P < 0. 05). Multivariate Logistic regression analysis showed that diabetes mellitus,use of broad-spectrum antibiotics for > 7 days,combination of antibiotic,use of glucocorticoid,tracheotomy were independent risk factors for XDRAB infection and colonization in patients with mechanical ventilation,and the area under the ROC curve( AUC value) was 0. 580,0. 649,0. 740,0. 572,0. 615,respectively. Conclusion XDRAB infection/colonization of lower respiratory tract in patients with mechanical ventilation is closely related to diabetes mellitus,use of broad-spectrum antibiotics for > 7 days,combination of antibiotics,use of glucocorticoid,and tracheotomy.The combination of antibiotics has better predictive value of infection than other risk factors. We provide guidance for the formulation of clinical infection prevention and control decisions.
引文
[1]周华,周建英,俞云松.中国鲍曼不动杆菌感染诊治与防控专家共识解读[J].中国循证医学杂志,2016,16(1):26-29.
[2]Kolpa M,Walaszek M,Gniadek A,et al.Incidence,Microbiological Profile and Risk Factors of Healthcare-Associated Infections in Intensive Care Units:A 10 Year Observation in a Provincial Hospital in Southern Poland[J].Int J Environ Res Public Health,2018,15(1):E112.
[3]Clinical and Laboratory Standards Institute.M100S Performance standards for antimicrobial susceptibility testing:twenty-sixth edition[S].2016.
[4]瞿介明,施毅.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)的更新与解读[J].中华结核和呼吸杂志,2018,41(4):244-246.
[5]Chaari A,Mnif B,Bahloul M,et al.Acinetobacter baumannii ventilator-associated pneumonia:epidemiology,clinical characteristics,and prognosis factors[J].Int J Infect Dis,2013,17(12):e1225-e1228.
[6]Sachdeva D,Singh D,Loomba P,et al.Assessment of surgical risk factors in the development of ventilator-associated pneumonia in neurosurgical intensive care unit patients:Alarming observations.[J].Neurol India,2017,65(4):779-784.
[7]汤同伟,桂淑玉.医院内下呼吸道鲍曼不动杆菌感染的临床特点及危险因素分析[J].中国现代医学杂志,2017,27(7):90-94.
[8]Dostalek M,Gohh RY,Akhlaghi F.Inosine monophosphate dehydrogenase expression and activity are significantly lower in kidney transplant recipients with diabetes mellitus[J].Ther Drug Monit,2013,35(3):374-383.
[9]Wu H,Chu C,Lin C,et al.Liver cirrhosis and diabetes mellitus are risk factors for Staphylococcus aureus infection in patients with healthcare-associated or hospital-acquired pneumonia[J].Pulm Med,2016,28(3):1-6.
[10]孙强,王丽环.糖尿病患者呼吸机相关性肺炎病原学分析[J].中华医院感染学杂志,2012,22(23):5230-5231.
[11]张颖,杨磊,钱小毛.糖尿病患者下呼吸道医院感染的临床特点[J].中华医院感染学杂志,2012,22(11):2277-2278.
[12]褚璐,胡少锋,张志华,等.糖尿病患者糖化血红蛋白水平与医院感染相关性研究[J].中华医院感染学杂志,2014,24(11):2729-2731.
[13]杨钧,王海燕,梁慧,等.机械通气患者下呼吸道细菌定植导致呼吸机相关性肺炎危险因素的前瞻性研究[J].中国呼吸与危重监护杂志,2013,12(3):253-257.
[14]Huang H,Chen B,Liu G,et al.A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii[J].BMC Infect Dis,2018,18(11):1-6.
[15]Hui C,Lin M,Jao M,et al.Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated patients with nosocomial infections[J].J Crit Care,2013,28(5):728-734.
[16]Kumar ST,Yassin A,Bhowmick T,et al.Recommendations from the 2016 guidelines for the management of adults with hospitalacquired or ventilator-associated pneumonia[J].P&T,2017,42(12):767-772.
[17]徐月,侯惠如.干预气管导管定植菌预防呼吸机相关性肺炎的研究进展[J].护理研究,2017,31(3):265-267.
[18]曾玲,张旭.气管切开术后下呼吸道感染的细菌分布及感染因素分析[J].现代预防医学,2012,39(22):5913-5914.
[19]Kumar R,Indrayan A.Receiver operating characteristic(ROC)curve for medical researchers[J].Indian Pediatr,2011,48(4):277-287.
[20]张乐,孙雯雯,刘玲玲.ROC曲线及Logistic回归评价WBC、CRP、D-D、FIB在肺炎支原体感染的诊断价值[J].国际检验医学杂志,2018,39(3):300-302.
[21]杨秀云,杨中良,黄飞华,等.血清C反应蛋白与前白蛋白比值对慢性阻塞性肺疾病伴下呼吸道细菌感染的早期诊断价值[J].中国医药导报,2015,12(23):97-100.
[2]Kolpa M,Walaszek M,Gniadek A,et al.Incidence,Microbiological Profile and Risk Factors of Healthcare-Associated Infections in Intensive Care Units:A 10 Year Observation in a Provincial Hospital in Southern Poland[J].Int J Environ Res Public Health,2018,15(1):E112.
[3]Clinical and Laboratory Standards Institute.M100S Performance standards for antimicrobial susceptibility testing:twenty-sixth edition[S].2016.
[4]瞿介明,施毅.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)的更新与解读[J].中华结核和呼吸杂志,2018,41(4):244-246.
[5]Chaari A,Mnif B,Bahloul M,et al.Acinetobacter baumannii ventilator-associated pneumonia:epidemiology,clinical characteristics,and prognosis factors[J].Int J Infect Dis,2013,17(12):e1225-e1228.
[6]Sachdeva D,Singh D,Loomba P,et al.Assessment of surgical risk factors in the development of ventilator-associated pneumonia in neurosurgical intensive care unit patients:Alarming observations.[J].Neurol India,2017,65(4):779-784.
[7]汤同伟,桂淑玉.医院内下呼吸道鲍曼不动杆菌感染的临床特点及危险因素分析[J].中国现代医学杂志,2017,27(7):90-94.
[8]Dostalek M,Gohh RY,Akhlaghi F.Inosine monophosphate dehydrogenase expression and activity are significantly lower in kidney transplant recipients with diabetes mellitus[J].Ther Drug Monit,2013,35(3):374-383.
[9]Wu H,Chu C,Lin C,et al.Liver cirrhosis and diabetes mellitus are risk factors for Staphylococcus aureus infection in patients with healthcare-associated or hospital-acquired pneumonia[J].Pulm Med,2016,28(3):1-6.
[10]孙强,王丽环.糖尿病患者呼吸机相关性肺炎病原学分析[J].中华医院感染学杂志,2012,22(23):5230-5231.
[11]张颖,杨磊,钱小毛.糖尿病患者下呼吸道医院感染的临床特点[J].中华医院感染学杂志,2012,22(11):2277-2278.
[12]褚璐,胡少锋,张志华,等.糖尿病患者糖化血红蛋白水平与医院感染相关性研究[J].中华医院感染学杂志,2014,24(11):2729-2731.
[13]杨钧,王海燕,梁慧,等.机械通气患者下呼吸道细菌定植导致呼吸机相关性肺炎危险因素的前瞻性研究[J].中国呼吸与危重监护杂志,2013,12(3):253-257.
[14]Huang H,Chen B,Liu G,et al.A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii[J].BMC Infect Dis,2018,18(11):1-6.
[15]Hui C,Lin M,Jao M,et al.Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated patients with nosocomial infections[J].J Crit Care,2013,28(5):728-734.
[16]Kumar ST,Yassin A,Bhowmick T,et al.Recommendations from the 2016 guidelines for the management of adults with hospitalacquired or ventilator-associated pneumonia[J].P&T,2017,42(12):767-772.
[17]徐月,侯惠如.干预气管导管定植菌预防呼吸机相关性肺炎的研究进展[J].护理研究,2017,31(3):265-267.
[18]曾玲,张旭.气管切开术后下呼吸道感染的细菌分布及感染因素分析[J].现代预防医学,2012,39(22):5913-5914.
[19]Kumar R,Indrayan A.Receiver operating characteristic(ROC)curve for medical researchers[J].Indian Pediatr,2011,48(4):277-287.
[20]张乐,孙雯雯,刘玲玲.ROC曲线及Logistic回归评价WBC、CRP、D-D、FIB在肺炎支原体感染的诊断价值[J].国际检验医学杂志,2018,39(3):300-302.
[21]杨秀云,杨中良,黄飞华,等.血清C反应蛋白与前白蛋白比值对慢性阻塞性肺疾病伴下呼吸道细菌感染的早期诊断价值[J].中国医药导报,2015,12(23):97-100.