影响重症监护病房耐碳青霉烯肠杆菌科细菌患者预后的多因素分析

Multivariate analysis of prognosis of carbapenem-resistant enterobacteriaceae infection patients in intensive care unit

目的探讨影响重症监护病房(ICU)感染碳青霉烯类抗生素耐药的肠杆菌科细菌(CRE)患者预后的独立危险因素。方法回顾性收集2017年1月至2018年10月本院ICU收治的感染CRE患者147例,根据预后分为存活组(n=57)和死亡组(n=90)。单因素分析两组间的差别,Logistic回归分析影响CRE感染患者预后的的独立危险因素。结果单因素分析显示,两组患者的性别、年龄、住院时间、住ICU时间、患者来源、联用抗生素、糖尿病史、急性生理和慢性健康评分(APACHEⅡ)比较差异有统计学意义(P<0.05)。Logistic回归分析显示,住ICU时间[OR=1.088,95%CI=1.046~1.131,P=0.000]、APACHEⅡ评分(OR=1.104,95%CI=1.006~1.207,P=0.036)和糖尿病史(OR=4.047,95%CI=1.460~11.218,P=0.007)是ICU中CRE发生的独立危险因素;住院时间(OR=0.933,95%CI=0.908~0.958,P=0.000)是CRE感染患者死亡的保护因素。结论住ICU时间、住院时间、糖尿病史、APACHEⅡ评分是引起CRE医院感染患者死亡的独立影响因素。

Objective To analyze the independent risk factors of prognosis of carbapenem-resistant enterobacteriaceae(CRE)infection patients in intensive care unit(ICU),which in favour of providing scientific basis for preventing and controling CRE.Methods All the consecutive eligible patients were analyzed retrospectively from among in patients who were hospitalized from January 2017 to October 2018,147 patients were included in the study and divided into thesurvial group(n=57)and the death group(n=90)based on the resistance to prognosis.The difference between two groups were analysed used single factor analysis and the independen t risk factors were analysed used Logistic regression analysis.Results The difference of sexuality,age,length of stay,duration of ICU,survival,diabetes history,acute physiology and chronic health(APACHEⅡ)score were found between the two groups.Logistic regression analysis showed duration of ICU[OR=1.088,95%CI=1.046-1.131,P=0.000],APACHEⅡscore(OR=1.104,95%CI=1.006-1.207,P=0.036),diabetes history(OR=4.047,95%CI=1.460-11.218,P=0.007)were the independent risk factors of prognosis of CRE infection patients in ICU,and length of stay(OR=0.933,95%CI=0.908-0.958,P=0.000)was the protective factor.Conclusion Duration of ICU,length of stay,APACHEⅡscore,diabetes history were the independent influence factors of prognosis of CRE infection patients in ICU.