ICU耐碳青霉烯类革兰阴性菌感染患者28d死亡的危险因素分析

Analysis of risk factors for 28-day death in patients with carbapenem-resistant Gram-negative bacterial infection in the ICU

目的了解重症监护病房(ICU)耐碳青霉烯类革兰阴性菌感染患者的病原菌特点,并分析影响患者28 d死亡的相关危险因素。方法选取2017年8月-2020年11月本院ICU收治的耐碳青霉烯类革兰阴性菌感染患者78例为研究对象,以确诊为耐碳青霉烯类革兰阴性菌感染后28 d临床结局为依据,将患者分为存活组(n=51)和死亡组(n=27),收集患者临床资料,以Logistic回归分析法分析影响患者28 d死亡的危险因素。结果 ICU耐碳青霉烯类革兰阴性菌感染患者病原菌主要包括鲍曼不动杆菌(66.67%,52/78)、肺炎克雷伯菌(14.10%,11/78)、铜绿假单胞菌(6.41%,5/78)等。存活组与死亡组在APACHEⅡ评分、有创通气时间、有无高血压、是否气管切开、是否使用多联抗菌药物、有无慢阻肺、有无恶性肿瘤、有无肾脏衰竭、有无呼吸衰竭方面比较差异有统计学意义(P<0.05)。APACHEⅡ评分(OR=1.411,95%CI=1.095~1.832)、肾脏衰竭(OR=2.287,95%CI=1.272~4.113)、呼吸衰竭(OR=2.858,95%CI=1.789~4.565)是影响患者28 d死亡的独立危险因素(均P<0.05),而有创通气时间、高血压、气管切开、使用多联抗菌药物、慢阻肺、恶性肿瘤并非其危险因素(均P>0.05)。结论 ICU耐碳青霉烯类革兰阴性菌感染患者28 d死亡的独立危险因素包括APACHEⅡ评分、肾脏衰竭、呼吸衰竭。

Objective To ascertain the characteristics of pathogenic bacteria in patients with a carbapenem-resistant Gram-negative bacterial infection in the intensive care unit(ICU) of Xuancheng People’s Hospital of Anhui Province and to analyze the relevant factors affecting the deaths of patients within 28 days. Methods Subjects were a total of 78 patients with a carbapenem-resistant Gram-negative bacterial infection who were admitted to the ICU of this Hospital from August 2017 to November 2020. Based on the clinical outcome 28 days after the diagnosis of a carbapenem-resistant Gram-negative bacterial infection, the patients were divided into 2 groups, those who survived(n=51) and those who died(n=27). Clinical data on the patients were collected, and the risk factors affecting the deaths of patients within 28 days were analyzed using logistic regression analysis. Results The pathogenic bacteria in patients with carbapenem-resistant Gram-negative bacterial infection in the ICU of Xuancheng People’s Hospital of Anhui Province were mainly Acinetobacter baumannii(66.67%, 52/78), Klebsiella pneumoniae,(14.10%, 11/78), and Pseudomonas aeruginosa(6.41%, 5/78). The APACHE Ⅱ score, the time on invasive ventilation, the presence of absence of hypertension, whether or not a tracheotomy was performed, receiving multiple antibacterials, the presence of absence of chronic obstructive pulmonary disease, the presence of absence of a malignant tumor, the presence of absence of kidney failure, and the presence of absence of respiratory failure differed significantly between patients who survived and patients who died(P<0.05). The APACHE Ⅱ score(OR=1.411, 95% CI=1.095-1.832), renal failure(OR=2.287, 95% CI=1.272-4.113), and respiratory failure(OR=2.858, 95% CI=1.789-4.565) were independent risk factors that affected the patient’s death within 28 days(P<0.05 for all) while the time on invasive ventilation, the presence of absence of hypertension, tracheotomy, receiving multiple antibacterials, the presence of absence of chronic obstructive pulmonary disease, and the presence of absence of a malignant tumors were not risk factors(P>0.05 for all). Conclusion The independent risk factors for the deaths within 28 days of patients with a carbapenem-resistant Gram-negative bacterial infection in the ICU of Xuancheng People’s Hospital of Anhui Province included the APACHE Ⅱ score, renal failure, and respiratory failure.