重症肺炎患者多药耐药菌感染的病原学及影响因素模型构建

Etiology of multi-drug resistant bacteria infection in severe pneumonia patients and the construction of influencing factors model

目的基于Logistic回归方程分析重症肺炎患者多药耐药菌感染的病原学特点及影响因素。方法回顾性选取2020年1月-2022年12月四川省医学科学院·四川省人民医院呼吸重症科收治的480例重症肺炎患者为研究对象,根据多药耐药菌感染情况分为研究组(多药耐药菌感染)189例和对照组(非多药耐药菌感染)291例;分析重症肺炎患者多药耐药菌感染的病原学特点及与临床资料的关系,利用多因素Logistic回归分析法分析重症肺炎患者多药耐药菌感染的影响因素,并构建影响因素模型;绘制受试者工作特征(ROC)曲线评价影响因素模型对重症肺炎患者多药耐药菌感染的预测价值。结果480例重症肺炎患者中,多药耐药菌感染189例,感染率为39.38%,共分离249株病原菌,以革兰阴性菌为主;肺炎类型为医院获得性肺炎、有肺部原发病、有侵入性检查或治疗、有抗菌药物联用、有入住重症监护病房(ICU)、血清C型反应性蛋白(CRP)水平高、血清白蛋白水平低是重症肺炎患者多药耐药菌感染的影响因素(P<0.05);构建的影响因素模型为Logit(P)=-10.553+肺炎类型为医院获得性肺炎×1.512+有肺部原发病×1.116+有侵入性检查或治疗×0.883+有抗菌药物联用×0.762+有入住ICU×0.553+血清CRP水平高×0.703+血清白蛋白水平低×0.910;该Logit(P)预测重症肺炎患者多药耐药菌感染的ROC曲线下面积为0.914,敏感度为85.19%,特异度为80.41%。结论重症肺炎患者多药耐药菌的感染率较高,且革兰阴性菌为主要致病菌,医院获得性肺炎、有肺部原发病等与重症肺炎患者多药耐药菌感染密切相关,据此构建的预测模型对重症肺炎患者多药耐药菌感染具有较好的预测价值。

OBJECTIVE To analyze influencing factors and etiological characteristics of multidrug-resistant pathogens infection in severe pneumonia patients based on logistic regression equation.METHODS Clinical data of 480 patients with severe pneumonia admitted to the respiratory intensive care department of Sichuan Academy of Medical Sciences Sichuan Provincial People′s Hospital from Jan 2020 to Dec 2022 were retrospectively collected as the research subjects,which were divided into the observation group(189 cases of multi-drug-resistant pathogens infection)and the control group(291 cases of non-multidrug-resistant pathogens infection)according to whether multi-drug-resistant pathogens infection occurred.The etiological characteristics of multidrug-resistant pathogens infection in patients with severe pneumonia and its relationship with clinical data were analyzed.The influencing factors for multidrug-resistant pathogens infection in patients with severe pneumonia were analyzed by multivariate logistic regression analysis,and the influencing factor model was built;the predictive value for multidrug-resistant pathogens infection in patients with severe pneumonia was evaluated using receiver operating characteristic(ROC)curve.RESULTS Among 480 patients with severe pneumonia,189 cases were infected with multidrug-resistant pathogens and the infection rate was 39.38%.A total of 249 strains of pathogens were isolated,mainly gram-negative bacteria.The types of pneumonia were hospital-acquired pneumonia;pulmonary primary disease,invasive examination or treatment,combination of antibiotics,admission to the intensive care unit(ICU),and high serum C-reactive protein(CRP)level and low serum albumin level were the influencing factors for multidrug-resistant pathogens infection in the patients with severe pneumonia(P<0.05).The influencing factor model was established as follows:Logit(P)=-10.553+the types of pneumonia being hospital-acquired pneumonia×1.512+pulmonary primary disease×1.116+invasive examination or treatment×0.883+combination of antibiotics×0.762+ICU admission×0.553+high serum CRP level×0.703+low serum albumin level×0.910.The area under ROC curve of this model for predicting multidrug-resistant pathogens infection in severe pneumonia patients was 0.914,with the sensitivity and the specificity of 85.19% and 80.41%,respectively.CONCLUSION The infection rate of multidrug-resistant bacteria is higher in patients with severe pneumonia,and gram-negative bacteria are the main pathogenic bacteria.Hospital-acquired pneumonia,pulmonary primary disease,invasive examination or treatment,antibiotic combination,ICU admission,high serum CRP level,low serum albumin level are closely related to multidrug-resistant bacteria infection in patients with severe pneumonia.The prediction model established by this method has good predictive value for multidrug-resistant bacteria infections in severe pneumonia patients.