急诊蜂蜇伤患者继发感染的危险因素分析

Risk factors for secondary infection in patients with bee stings in emergency

目的探讨急诊蜂蜇伤患者发生感染的危险因素,以期为早期干预提供依据。方法采用回顾性研究的方法。选择2019年1月1日至2021年12月31日就诊于四川大学华西医院急诊科的蜂蜇伤患者作为研究对象。采集患者的人口学特征,记录性别、年龄、蜇伤蜂种、蜇伤部位及皮损处、蜇伤至就诊时间、临床表现、基本生命体征、院内结局指标。根据就诊后3 d内是否发生感染将患者分为感染组和非感染组。比较两组患者一般情况、受伤情况、临床表现及预后指标的差异;采用Logistic回归模型分析感染发生的独立危险因素,并绘制受试者工作特征曲线(ROC曲线),评价各危险因素对患者发生感染的预测价值。结果共收集282例蜂蜇伤患者,入院3 d内感染发生率为19.5%(55/282)。与非感染组比较,感染组患者年龄明显增大〔岁:51(38,67)比44(27,57)〕,蜇伤至就诊时间明显延长〔h:20(7,48)比3(1,24)〕、头面颈部蜇伤、蜇伤皮损数≥10处、伴皮肤外其他系统症状、就诊时体温、收缩压、血氧饱和度(SpO2)均明显升高〔头面颈部蜇伤:74.5%(41/55)比25.1%(57/227),蜇伤皮损数≥10处:52.7%(29/55)比5.3%(12/227),伴皮肤外其他系统症状:60.0%(33/55)比16.7%(38/227),体温(℃):36.5(36.3,36.9)比36.4(36.1,36.6),收缩压(mmHg,1 mmHg≈0.133 kPa):139(119,154)比128(117,144),SpO2:0.97(0.95,0.98)比0.98(0.96,0.99),均P<0.05〕。多因素Logistic回归分析显示,蜇伤皮损数≥10处、伴皮肤外其他系统症状、就诊时体温是急诊蜂蜇伤患者发生感染的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为:5.127(1.766~14.890)、2.424(1.050~5.595)、5.977(1.733~20.154),均P<0.05〕。基于上述3项指标构建蜂蜇伤患者早期感染风险预警模型,ROC曲线分析显示,预警模型、快速序贯器官衰竭评分(qSOFA)、英国国家早期预警评分(NEWS)对蜂蜇伤患者发生早期感染有一定的预测价值,ROC曲线下面积(AUC)和95%CI分别为0.873(0.812~0.935)、0.600(0.509~0.690)、0.741(0.602~0.819),P值分别为<0.001、0.022、0.001,敏感度分别为78.2%、25.5%、65.5%,特异度分别为89.0%、94.3%、75.8%。感染组预后相关指标入院率和急性肾损伤(AKI)发生率均较非感染组明显升高(入院率:12.7%比0.4%,AKI发生率:32.7%比1.3%,均P<0.05)。结论蜂蜇伤患者早期即可发生感染,蜇伤皮损数≥10处、伴随皮肤外其他系统症状、就诊时体温为蜂蜇伤后发生早期感染的独立危险因素,基于此3项指标构建的预警模型可用于筛选蜂蜇伤后早期继发感染的高危人群。

Objective To explore the risk factors for occurrence of secondary infection in patients with bee stings in emergency in order to provide evidence for early interference.Methods A retrospectively research was conducted,and patients with bee stings who visited to the department of emergency of West China Hospital of Sichuan University from January 1,2019 to December 31,2021 were selected as the study subjects.Gender,age,bee species,sting site and number of skin lesions,time from sting to hospital visit,clinical manifestations,basic vital signs and inhospital outcome indicators were recorded as the demographic characteristics.The patients were divided into two groups:infected and non-infected,according to the occurrence of infection within 3 days of the visit or not.The differences in general conditions,injuries,clinical manifestations and prognostic indicators of the patients in the two groups were compared;Logistic regression model analysis was used to analyze the independent risk factors of secondary infection occurrence,and receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for infection in the patients.Results A total of 282 patients with bee stings were included,the incidence of infection within 3 days after admission was 19.5%(55/282).Compared with the non-infected group,the patients in the infected group were significantly older[age:51(38,67)vs.44(27,57)],and had a significantly longer time from sting to hospital visit[hours:20(7,48)vs.3(1,24)];stings on the head,face and neck,number of stings lesions≥10,accompanied by systemic symptoms other than skin,body temperature,and systolic blood pressure were significantly higher and pulse oxygen saturation(SpO2)at the time of consultation in the infected group was higher[head,face,and neck stings:74.5%(41/55)vs.25.1%(57/227),number of stings lesions≥10:52.7%(29/55)vs.5.3%(12/227),accompanied by systemic symptoms other than skin:60.0%(33/55)vs.16.7%(38/227),body temperature(℃):36.5(36.3,36.9)vs.36.4(36.1,36.6),systolic blood pressure(mmHg,1 mmHg≈0.133 kPa):139(119,154)vs.128(117,144),SpO2:0.97(0.95,0.98)vs.0.98(0.96,0.99),all P<0.05].Multi-factorial Logistic regression analysis showed that the number of stings lesions≥10,accompanied by systemic symptoms other than skin and body temperature at admission were independent risk factors for the development of infection in patients with bee stings[odds ratio(OR)and 95%confidence interval(95%CI)were:5.127(1.766-14.890),2.424(1.050-5.595),5.977(1.733-20.154),all P<0.05].The early warning model for the risk of early infection in bee sting patients was constructed based on the above 3 indicators,the ROC curve analysis showed that the early warning model,the quick sequential organ failure assessment(qSOFA)score,and the English national early warning score(NEWS)have certain predictive values for early infection in patients with bee stings,the area under ROC curve(AUC)and 95%CI were 0.873(0.812-0.935),0.600(0.509-0.690),and 0.741(0.602-0.819),respectively,with P values of<0.001,0.022,and 0.001,sensitivity of 78.2%,25.5%,and 65.5%,and the specificity was 89.0%,94.3%,and 75.8%,respectively.The prognostic indicators of admission rate and the incidence of acute kidney injury(AKI)in the infected group were significantly higher than those in the noninfected group(admission rate:10.9%vs.0.4%,incidence of AKI:32.7%vs.1.3%,both P<0.05).Conclusions The secondary Infection can occur early in patients with bee stings.The number of stings lesions≥10,accompanied by systemic symptoms other than skin,and the body temperature at admission are the risk factors for early infection after bee stings.An early warning model constructed and based on these 3 indicators could be used to identify patients at high risk of secondary infection after bee stings.