酒精滥用与非酒精滥用的重症监护室患者微生物学感染指标及药敏结果的差异

Differences in microbiology and bacterial susceptibility between alcohol abuse and no alcohol abuse in intensive care unit patients

目的探讨酒精滥用与非酒精滥用成人重症监护室(intensive care unit,ICU)患者微生物学感染指标检查结果的差异以及酒精滥用与其差异的关系。方法收集的研究对象数据来源于重症监护医学信息市场Ⅲ(medical information mart for intensive careⅢ,MIMIC-Ⅲ)数据库。筛选出存在微生物学感染指标检查结果的成年患者,按照是否为酒精滥用分为两组,使用倾向性评分进行匹配,匹配方法为最近邻匹配,匹配比例为1∶1,卡钳值为0.02,评估匹配后两组患者微生物学感染指标检查结果的异同。非正态分布的计量资料采用M(Q1,Q3)表示,两组比较采用Wilcoxon秩和检验;计数资料的比较采用χ^(2)检验或Fisher确切概率法。结果与非酒精滥用组相比,匹配后酒精滥用组使用机械通气比例较高[47.06%(1379/2930)与52.66%(1543/2930),χ^(2)=18.14,P<0.001];痰液标本中检测阳性患者比例较高[44.30%(400/903)与49.41%(501/1014),χ^(2)=4.81,P=0.028];而在其他标本中检测阳性比例较低[26.85%(653/2432)与21.67%(541/2496),χ^(2)=17.69,P<0.001]。在血液标本中,酒精滥用组检测出革兰阴性菌比例较低[26.87%(126/469)与17.25%(74/429),χ^(2)=11.42,P<0.001],而检测出革兰阳性菌比例较高[78.46%(368/469)与86.01%(369/429),χ^(2)=8.17,P=0.004]。酒精滥用组中检测出铜绿假单胞菌[3.75%(110/2930)与2.08%(61/2930),χ^(2)=13.88,P<0.001]和肠球菌属细菌[8.19%(240/2930)与6.45%(189/2930),χ^(2)=6.29,P=0.012]的患者占比较非酒精滥用组低,而检测出耐甲氧西林金黄色葡萄球菌[2.32%(68/2930)与3.28%(96/2930),χ^(2)=4.57,P=0.032]及流感嗜血杆菌[1.30%(38/2930)与2.01%(59/2930),χ^(2)=4.19,P=0.041]的患者占比较高。对于金黄色葡萄球菌[61.10%(322/527)与52.66%(267/507),χ^(2)=7.16,P=0.007]和肠球菌属细菌[75.83%(160/211)与63.64%(56/88),χ^(2)=4.02,P=0.045],酒精滥用组对左氧氟沙星的耐药率较低;对于大肠杆菌、铜绿假单胞菌和肺炎克雷伯菌,酒精滥用组对头孢菌素类抗生素的耐药率较低(均P<0.001)。结论存在酒精滥用可能增加成人ICU患者使用机械通气的风险,酒精滥用患者可能较易发生呼吸道感染。酒精滥用患者合并血液感染检测出革兰阴性菌比例较低,但革兰阳性菌比例较高,并且酒精滥用可能增加感染流感嗜血杆菌及耐甲氧西林金黄色葡萄球菌的风险。酒精滥用患者感染的金黄色葡萄球菌、肠球菌属细菌、大肠杆菌、铜绿假单胞菌及肺炎克雷伯菌对多数抗生素耐药率要低于非酒精滥用患者。

Objective To investigate the differences in microbiological examination results between alcohol abuse and no alcohol abuse in adult ICU patients and the association between alcohol abuse and these differences.Methods The adult patients with microbiological examination results were selected from the MIMIC-Ⅲdatabase and divided into two groups according to whether they had alcohol abuse.The two groups were matched by propensity score,and the similarities and differences in microbiological examination results were evaluated between the two groups after matching.The measurement data of non normal distribution were expressed by M(Q1,Q3).Wilcoxon rank sum test was used for the comparison of the two groups,and the comparison of counting data was usedχ^(2) test or Fisher exact probability method.Results After matching,the alcohol abuse patients were more likely to use mechanical ventilation(47.06%(1379/2930)vs.52.66%(1543/2930),χ^(2)=18.14,P<0.001),had a higher positive rate in sputum samples(44.30%(400/903)vs.49.41%(501/1014),χ^(2)=4.81,P=0.028)and had a lower positive rate in other samples(26.85%(653/2432)vs.21.67%(541/2496),χ^(2)=17.69,P<0.001).In blood samples,the percentage of Gram-negative bacteria was lower in the alcohol abuse group(26.87%(126/469)vs.17.25%(74/429),χ^(2)=11.42,P<0.001),while the percentage of Gram-positive bacteria was higher(78.46%(368/469)vs.86.01%(369/429),χ^(2)=8.17,P=0.004).The percentage of patients with Pseudomonas aeruginosa(3.75%(110/2930)vs.2.08%(61/2930),χ^(2)=13.88,P<0.001)and Enterococcus sp.(8.19%(240/2930)vs.6.45%(189/2930),χ^(2)=6.29,P=0.012)was lower in the alcohol abuse group.However,there was a higher percentage of patients with methicillin-resistant Staphylococcus aureus(2.32%(68/2930)vs.3.28%(96/2930),χ^(2)=4.57,P=0.032)and Haemophilus influenzae(1.30%(38/2930)vs.2.01%(59/2930),χ^(2)=4.19,P=0.041)in the alcohol abuse group.For Staphylococcus aureus(61.10%(322/527)and 52.66%(267/507),χ^(2)=7.16,P=0.007)and Enterococcus sp.(75.83%(160/211)and 63.64%(56/88),χ^(2)=4.02,P=0.045),the alcohol abuse group had a lower resistance to levofloxacin;for Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae,the alcohol abuse group had a lower resistance to cephalosporins(all P<0.05).Conclusions In adult ICU,alcohol abuse might increase the risks of using mechanical ventilation,and patients with alcohol abuse might be more prone to have respiratory tract infections.Alcohol abuse patients with blood infections were less likely to be infected with Gram-negative bacteria,but had a higher probability of Gram-positive bacteria infection.What is more,Alcohol abuse might increase the risks of infections with Haemophilus influenzae and methicillin-resistant Staphylococcus aureus.In alcohol abuse patients,the infection of Staphylococcus aureus,Enterococcus sp.,Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae was less resistant to many antibiotics than that in no alcohol abuse patients.