潜在DCD供者携带耐碳青霉烯革兰阴性菌的危险因素分析

An analysis of risk factors for organ donation after citizen's death to carry carbapenem-resistant Gram-negative bacteria

目的探讨潜在公民逝世后器官捐献(DCD)供者携带耐碳青霉烯革兰阴性菌(CRGNB)的危险因素.方法器官获取组织评估的潜在DCD供者319例.收集供者的人口学特征、临床基本数据、既往慢性病史、侵入性操作等一般资料,采用单因素分析及多因素logistic回归分析潜在DCD供者携带CRGNB的危险因素.结果潜在DCD供者CRGNB分离率为22.6%(72/319);共分离出CRGNB 98株(前3位是鲍曼不动杆菌、绿脓杆菌和肺炎克雷伯菌).分离标本主要来源于痰液、血液和尿液.多因素logistic回归分析示,ICU停留>5 d、有呼吸道感染、有糖尿病病史和碳青霉烯类抗生素应用史是潜在DCD供者携带CRGNB的独立危险因素(P<0.05).结论潜在DCD供者携带CRGNB危险因素为ICU停留>5 d、有呼吸道感染、糖尿病病史和碳青霉烯类抗生素应用史.针对此类供者应加强CRGNB筛查,并积极建立早期预警机制.

Objective To analyze the risk factors for the organ donation after citizen's death(DCD)to carry carbapenem:resistant Gram negative bacteria(CRGNB).Methods A total of 319 potential DCD donors were selected by organ procurement organization and the relevant demographic characteristics,clinical basic data,chronic diseases history,invasive operation and other general data of the donors were collected.The univariate analysis and multivariate logistic regression were performed to analyze the risk factors of DCD potential donors to carry CRGNB.Results The isolation rate of CRGNB from potential DCD donors was 22.6%(72/319),which included 98 strains(in an order of Acinetobacter baumannii,Pseudomonas aeruginosa and K lebsiella pneumoniae).The isolated specimens included mainly sputum,blood and urine.Multivariate logistic regression analysis showed that ICU stay>5 days,respiratory tract infection,history of diabetes mellitus and history of carbapenem antibiotic use were the independent risk factors for DCD potential donors to carry CRGNB(P<0.05).Conclusion The risk factors for DCD potential donors to carry CRGNB are ICU stay>5 days,respiratory tract infection,history of diabetes mellitus and history of carbapenem antibiotic use,An attention should be paied to screening CRGNB and early warning es tablishing mechanism,