急性心肌梗死患者介入治疗后感染病原菌及其危险因素模型构建

Pathogenic bacteria of nosocomial infection after intervention in patients with acute myocardial infarction and construction of its risk factor model

目的分析急性心肌梗死(AMI)患者介入治疗后医院感染病原菌,构建并评价危险因素模型.方法选择开封市人民医院2019年10月-2022年10月收治的行介入治疗的498例AMI患者依据医院感染情况分为医院感染组(n=31)、非医院感染组(n=467).分析AMI患者介入治疗后医院感染部位、病原菌,归纳AMI患者介入治疗后医院感染的危险因素并建立模型,采用受试者工作特征(ROC)曲线分析危险因素模型对AMI患者介入治疗后医院感染的预测价值.结果AMI患者介入治疗后医院感染的感染部位主要为下呼吸道(占51.61%);498例AMI患者介入治疗后医院感染发生率为6.22%,其中革兰阴性菌占64.71%,革兰阳性菌占25.49%,真菌占9.80%;多因素Logistic分析结果显示,心力衰竭(OR=1.898)、低蛋白血症(OR=1.719)为AMI患者介入治疗后医院感染的危险因素(P<0.05);血清Hb水平升高(OR=0.508)为AMI患者介入治疗后医院感染的保护因素(P<0.05);将上述因素纳入危险因素模型:Logit(P)=-12.489+0.641×心力衰竭+0.542×低蛋白血症-0.678×血清Hb水平,当Logit(P)>6.85时,曲线下面积(AUC)为0.875,95%CI为0.842~0.902,x2=13.165,诊断灵敏度83.87%、特异度为80.30%.结论AMI患者介入治疗后医院感染以呼吸道感染为主,主要病原菌为革兰阴性菌,多种因素与AMI患者介入治疗后医院感染发生密切相关,构建危险因素模型其具有一定预测价值.

OBJECTIVE To analyze the pathogenic bacteria of nosocomial infection after intervention in patients with acute myocardial infarction(AMI)and to construct and evaluate the constructed model of their risk factors.METHODS From Oct.2019 to Oct.2022,498 AMI patients treated by interventional therapy in Kaifeng People's Hospital were divided into nosocomial infection group(n=31)and non-nosocomial infection group(n=467)according to whether nosocomial infection occurred or not.The sites and pathogenic bacteria of nosocomial infection in patients with AMI after interventional therapy were analyzed,the risk factors of nosocomial infection in patients with AMI after interventional therapy were summarized and models were established.The predictive value of the risk factor model for nosocomial infection after interventional therapy in patients with AMI was analyzed by receiver operating characteristic curve(ROC)curve.RESULTS The main part of nosocomial infection in patients with AMI after interventional treatment was the lower respiratory tract,accounting for 51.61%.The incidence of nosocomial infection in 498 AMI patients after interventional therapy was 6.22%,of which 64.71%were gram-negative bacteria,25.49%were gram-positive bacteria and 9.80%were fungi.Multivariate Logistic analysis showed that heart failure and hypoproteinemia were the risk factors for nosocomial infection in patients with AMI after interventional therapy(OR=1.898,1.719,P<0.05).Elevated serum Hb level was a protective factor for nosocomial infection in patients with AMI after interventional therapy(OR=0.508,P<0.05).The above indicators were included in the risk factor model:logit(P)=-12.489+0.641 X heart failure+0.542X hypoproteinemia-0.678X serum Hb level.When logit(P)>6.85,the area under the curve(AUC)was 0.875,95%CI was 0.842-0.902,X2=13.165.The diagnostic sensitivity was 83.87%and the specificity was 80.30%.CONCLUSION Respiratory tract infection was the main cause of nosocomial infection after interventional therapy in patients with AMI,and gram-negative bacteria were the main pathogenic bacteria.Multiple factors were closely related to the occurrence of nosocomial infection in patients with AMI after interventional therapy,and the construction of risk factor model had a certain predictive value.