综合重症监护病房老年患者多重耐药菌感染危险因素分析及预测模型建立

Analysis of risk factors and establishment of prediction model of multidrug-resistant organism infection in elderly patients in comprehensive intensive care unit

目的探讨综合重症监护病房(ICU)老年患者多重耐药菌感染危险因素,构建ICU老年患者感染多重耐药菌的预测模型。方法回顾性分析2019年1月—2019年12月入住复旦大学附属中山医院吴淞医院ICU共613例老年患者的临床资料,采用单因素和Logistic多因素回归模型,分析ICU老年患者多重耐药菌感染的独立危险因素,并根据Logistic回归分析结果构建预测模型,通过受试者工作特征曲线(ROC)检验拟合优度。结果留置中心静脉导管(OR=3.205,95%CI:1.204~8.533)、气管插管(OR=4.259,95%CI:2.008~9.034)、留置导尿管(OR=7.542,95%CI:1.335~42.615)以及住院天数≥7d(OR=18.534,95%CI:6.576~52.239)是ICU老年患者多重耐药菌感染的危险因素。ROC曲线下面积为0.963 (95%CI:0.948~0.978),模型拟合度较好。结论根据留置中心静脉导管、气切插管、留置导尿管以及住院天数≥7d构建的预测模型对预判ICU老年患者多重耐药菌感染有较好的效果,对于指导医院公共卫生防控和临床工作,降低ICU多重耐药菌感染率有较高应用价值。

Objective To explore the risk factors of multidrug-resistant organism(MDRO)infection in the elderly patients in comprehensive intensive care unit(ICU),and establish a prediction model. Methods The clinical data of613 elderly patients admitted to ICU of Wusong Branch of Zhongshan Hospital Affiliated to Fudan University from January2019 to December2019 were retrospectively analyzed. Univariate and logistic regression model were used to analyze the independent risk factors of MDRO infection in elderly patients in ICU. The prediction model was established according to the results of logistic regression analysis. The goodness of fit of the model was assessed with the receiver operating characteristic curve(ROC). Results Indwelling central venous catheter(OR= 3.205, 95% CI: 1.204-8.533),endotracheal intubation(OR= 4.259, 95% CI: 2.008-9.034),indwelling urinary catheter(OR= 7.542, 95% CI: 1.335-42.615)and hospitalization days≥7 days(OR= 18.534, 95% CI: 6.576-52.239)were risk factors of MDRO infection in elderly patients in ICU.The area under ROC curve was0.963(95% CI: 0.948 ~0.978),and the fitting degree of the model was good. Conclusion The prediction model established according to indwelling central venous catheter,endotracheal intubation,indwelling urinary catheter and hospitalization days≥7 days has a good effect on predicting MDRO infection in elderly patients in ICU,and has high application value in guiding the public health prevention and control and clinical work of hospitals and reducing the infection rate of MDRO in the ICU.