ICU中革兰阴性菌血流感染的危险因素分析

Analysis on risk factors of Gram-negative bacterial blood-stream infection in ICU

目的分析ICU革兰阴性(G-)菌引起的血流感染的危险因素,以进行风险评估并指导用药。方法回顾性调查分析2013年1月至2014年12月武汉大学人民医院ICU诊断为G-菌血流感染的住院患者,通过Logistic回归分析筛选G-菌引起的血流感染的危险因素。结果 2013年1月至2014年12月,ICU发生血流感染172例次,其中G-菌引起者93例次。G-菌血流感染致病菌有鲍曼不动杆菌、肺炎克雷伯杆菌、鲍氏醋酸钙不动杆菌、大肠埃希菌、铜绿假单胞菌等;除大肠埃希菌主要来自于社区感染外,其他细菌均主要来自于医院感染。为区别于其他病原菌血流感染,Logistic回归分析结果显示ICU G-菌血流感染的独立危险因素有:血清降钙素原(PCT)≥10.0ng/mL(OR=60.52,P=0.001)、之前接受碳青霉烯类及三代头孢治疗(OR=16.09,P=0.03)、患病前住院天数小于2周(OR=13.79,P=0.03)、有消化系统基础疾病(OR=12.94,P=0.01)。结论武汉大学人民医院ICU科G-菌血流感染以多重耐药菌为主,血清PCT≥10.0ng/mL、之前接受碳青霉烯类及三代头孢治疗、患病前住院天数小于2周、有消化系统基础疾病是影响其发生、诊断的独立危险因素。

Objective To analyze the risk factors of Gram-negative bacterial blood-stream infection in ICU for conducting the risk evaluation and guiding medication.Methods The inpatients were diagnosed with Gram-negative bacterial blood-stream infection in ICU of the Renmin Hospital of Wuhan University from January 2013 to December 2014 were retrospectively surveyed and analyzed.The risk factors of blood-stream infection caused by Gram-negative bacteria were analyzed and screened by the Logistic regression analysis method.Results A total of 172case-times of blood-stream infection occurred in ICU during this period,including93case-times of Gram-negative bacterial infection.The Gram-negative pathogenic bacteria were Acinetobacter baumanii,Klebsiella pneumoniae,Acinetobacter calcoaceticus baumanii,E.coli,pseudomonas aeruginosa,etc.Except E.coli was mainly originated from community acquired infection,other bacteria were mainly originated from nosocomial infection.In order to differing from other pathogenic bacterial blood stream infection,the Logistic regression analysis results showed that the independent risk factors of Gnegative bacterial blood-stream infection in ICU had serum PCT levels over 10.0ng/mL（OR=60.52,P=0.001）,receiving the therapy of carbapenem and third generation cephalosporins（OR=16.09,P=0.03）,hospitalization duration less than 2weeks before suffering from disease（OR=13.79,P=0.03）and digestive system basic disease（OR=12.94,P=0.01）.Conclusion Gramnegative bacterial blood-stream infection in ICU of the Renmin Hospital of Wuhan University is mainly caused by multi-drug resistant bacteria.Serum PCT level over 10.0ng/mL,hospitalization duration less than 2weeks before infection,receiving the therapy of carbapenem and third generation cephalosporin and basic diseases of digestive system are the independent risk factors influencing the occurrence and diagnosis of blood-stream infection.