成人2型糖尿病患者社区发生血流感染的危险因素和病原菌特征

Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection

目的研究成人2型糖尿病(T2DM)患者社区发生血流感染(COBSI)的危险因素和病原菌特征,为早期诊治提供理论依据。方法回顾分析合肥市第二人民医院2017年1月-2020年3月成人社区发生感染的T2DM住院患者293例,根据48 h内血培养结果分为血流感染(BSI)组和对照组,分析危险因素,构建预测模型,检验模型。分析社区获得性血流感染(CABSI)和医疗健康相关性血流感染(HCABSI)组间的病原菌特点。结果构建预测模型P=1/(1+e-y),y=-45.137+0.751×院外或入院48 h内体温峰值+0.033×中性粒细胞百分比+0.027×血浆渗透压+0.009×血C反应蛋白+1.144×肾功能衰竭+1.740×糖尿病酮症酸中毒(DKA),模型曲线下面积(AUC)为0.800,95%CI为(0.747~0.853),最佳截断值为0.208,灵敏度为0.90,特异度为0.56。对模型的校准度予以Hosmer-lemeshow检验,χ^2=12.285,P=0.139。CABSI和HCABSI组间在革兰阴性菌(G-)、大肠埃希菌、产超广谱β-内酰胺酶大肠埃希菌、革兰阳性菌(G+)和金黄色葡萄球菌的检出差异均具有统计学意义(均有P<0.05)。结论院外或入院48 h内体温峰值、中性粒细胞百分比、血浆渗透压、血C反应蛋白、肾功能衰竭、DKA是成人T2DM患者COBSI的危险因素。预测模型具有较高的灵敏度,CABSI和HCABSI组间病原菌存在差异,对早期诊治具有临床指导意义。

Objective To analyze the risk factors and pathogen characteristics of adult type 2 diabetes mellitus(T2 DM)patients with community-onset bloodstream infection(COBSI)risk,so as to provide theoretical basis for early diagnosis and treatment.Methods A total of 293 T2 DM inpatients who were admitted to the Second People’s Hospital of Hefei from the adult community during 2017/01-2020/03 were retrospectively analyzed,which were divided into bloodstream infection(BSI)group and control group according to the blood results within 48 hours.Based on the analysis of the risk factors,prediction model and test model were constructed.The characteristics of pathogenic bacteria was analyzed on community acquired bloodstream infection(CABSI)group and health care-associated community acquired bloodstream infection(HCABSI)group.Results The prediction model was established.P=1/(1+e-y),y=-45.137+0.751×peak body temperature outside the hospital or within 48 h of admission+0.033×neutrophil percentage+0.027×plasma osmotic pressure+0.009×blood C-reactive protein+1.144×kidney failure+1.740×diabetic ketoacidosis.The area under a curve(AUC)of the model was 0.800,95%CI was from 0.747 to 0.853,and the optimal cutoff value was 0.208 and the sensitivity was 0.90,specificity was 0.56.Hosmer-lemeshow test was performed for the calibration degree of the model,χ^2=12.285,P=0.139.There were statistically significant differences(all P<0.05)between CABSI and HCABSI groups in Gram-negative bacteria(G-),extended-spectrumβ-lactamases-producing Escherichia coli,Escherichia coli,Gram-positive bacteria(G+)and Staphylococcus aureus.Conclusions Peak body temperature outside the hospital or within 48 hours of admission,neutrophil percentage,plasma osmotic pressure,serum C-reactive protein,kidney failure,and diabetic ketoacidosis are risk factors for COBSI in adult T2 DM patients.The prediction model has good sensitivity,and there are differences in pathogenic bacteria between CABSI and HCABSI groups,which has clinical guiding significance for early diagnosis and treatment.