创伤性颅脑损伤患者继发感染的临床特点及危险因素

Clinical characteristics and risk factors of secondary infection in patients with traumatic brain injury

目的探讨重症医学科(ICU)创伤性颅脑损伤患者继发感染的临床特点及危险因素。方法选取2014年10月至2021年6月在濉溪县医院ICU诊断为创伤性颅脑损伤(TBI)患者288例,分析其继发感染的临床特点,并采用多因素logistic回归分析TBI患者继发感染的危险因素。结果288例TBI患者共发生感染130例次,最常见的感染是呼吸机相关性肺炎(VAP)37例,占12.85%;其次是泌尿系感染(UTI)29例,占10.07%;中枢神经系统感染18例,占6.25%;导管相关性血流感染(CRBSI)24例,占8.33%;外科部位感染(SSI)22例,占7.64%。TBI患者继发感染的危险因素分析表明:年龄、ICU住院日、入院时GCS评分等因素是引起继发感染的独立危险因素(P<0.001),而患者的28 d及总病死率仅与入院时GCS评分相关(P<0.001)。结论TBI患者继发感染与患者的年龄、ICU住院日、入院时GCS评分等因素有关。

Objective To explore the clinical characteristics and risk factors of secondary infection in patients with traumatic brain injury(TBI)in intensive care unit(ICU).Methods Between October 2014 and June 2021,288 patients with TBI were enrolled from ICU in Sui Xi county hospital.The clinical data of patients was analyzed.Multivariate logistic regression was used to evaluate risk factor for infection after TBI.Results Out of 288 patients,a total of 130 cases of infection occurred,the majority were ventilator associated pneumonia(VAP,37 cases,12.85%),followed by urinary tract infection(UTI,29 cases,10.07%),central nervous system infection(18 cases,6.25%),catheter-related blood stream infection(CRBSI,24 cases,8.33%)and surgical site infection(SSI,22 cases,7.64%).The etiology of infection were mainly dominated by enterobacter and non-fermenting bacteria(NFB,60.77%),followed by multidrug-resistant(MDR,45.38%).Analysis of risk factors for secondary infection in TBI patients showed that age,length of ICU stay,and GCS score at admission were independent risk factors for secondary infections(P<0.001),and the 28-day mortality and total mortality were only associated with GCS score on admission(P<0.001).Conclusions The secondary infection in TBI patients is related to factors including age,length of ICU stay,and GCS score at admission.