危重病科患者合并血流感染的影响因素及病原菌分析

Analysis of influencing factors and pathogen in critically ill patients complicated with bloodstream infection

目的探讨危重病科患者合并血流感染的影响因素及病原菌。方法选择2020年1—6月广州医科大学附属第六医院危重病科收治的162例合并血流感染患者为观察组,162例未合并血流感染患者为对照组。收集资料,分析危重病科患者合并血流感染的影响因素及病原菌。结果单因素分析结果提示,观察组年龄、脑血管疾病、糖尿病、中心静脉置管、机械通气时间>5 d、入院前30 d内使用抗菌药物与对照组比较,差异有统计学意义(P<0.05)。多因素分析结果提示,年龄≥60岁(β=1.606,OR=4.982,95%CI=2.862~8.671)、脑血管疾病(β=1.203,OR=3.329,95%CI=1.969~5.628)、糖尿病(β=0.774,OR=2.168,95%CI=1.345~3.495)、机械通气时间>5 d(β=1.613,OR=5.017,95%CI=3.115~8.080)、入院前30 d内使用抗菌药物(β=0.900,OR=2.460,95%CI=1.461~4.143)是危重病科患者合并血流感染的高危因素(P<0.05)。观察组中162例患者的血培养样本中分离出病原菌251株,其中革兰阴性菌155株(61.75%),革兰阳性菌86株(34.27%),真菌10株(3.98%)。结论危重病科患者合并血流感染与年龄、机械通气时间、使用抗菌药物和合并脑血管疾病、糖尿病有关,革兰阴性菌是其主要致病菌,临床需针对各危险因素加强护理干预,以减少血流感染发生。并根据病原菌实施药敏试验,按照试验结果合理选择抗菌药物,提高治疗效果。

Objective To investigate the influencing factors and pathogen in critically ill patients complicated with bloodstream infection.Methods A total of 162 patients complicated with bloodstream infections admitted to the Critical Care Department of the Sixth Affiliated Hospital of Guangzhou Medical University from January to June 2020 were selected as the observation group,and a total of 162 patients without bloodstream infection were selected as the control group.Data were collected and the influencing factors and pathogens in critically ill patients complicated with bloodstream infections were analyzed.Results The results of univariate analysis suggested that the observation group′s age,cerebrovascular disease,diabetes,central venous catheterization,mechanical ventilation period>5 d,and the use of antibacterial drugs within 30 d before admission were statistically different from those in the control group after comparison(P<0.05).The results of multivariate analysis suggested that age≥60 years old(β=1.606,OR=4.982,95%CI=2.862-8.671),cerebrovascular disease(β=1.203,OR=3.329,95%CI=1.969-5.628),diabetes(β=0.774,OR=2.168,95%CI=1.345-3.495),mechanical ventilation period>5 d(β=1.613,OR=5.017,95%CI=3.115-8.080),antibacterial drugs used within 30 d before admission(β=0.900,OR=2.460,95%CI=1.461-4.143)were high-risk factors for critical ill patients complicated with bloodstream infections(P<0.05).A total of 251 pathogenic bacteria were separated from hemoculture samples of 162 patients in the observation group,including 155 Gram-negative bacteria(61.75%),86 Gram-positive bacteria(34.27%),and 10 fungi(3.98%).Conclusion Critically ill patients complicated with bloodstream infections are related to age,mechanical ventilation period,use of antibacterial drugs,complication of cerebrovascular diseases,and diabetes.Gram-negative bacteria are the main pathogenic bacteria of critically ill patients complicated with bloodstream infections.Clinical nursing interventions should be strengthened for various risk factors to reduce the occurrence of bloodstream infections.Targeting on the pathogenic bacteria,drug susceptibility tests are carried out,and antibacterial drugs are reasonably selected according to the test results to enhance the therapeutic effect.