ICU患者多重耐药菌感染特点及预后影响因素分析

Analysis of the characteristics and prognostic influencing factors of multidrug-resistant organism infection in ICU patients

目的分析重症监护室(ICU)患者多重耐药菌(MDRO)感染特点和预后影响因素,为MDRO的预防和治疗提供参考。方法回顾性收集2018年1月至2023年12月收治于新疆医科大学第一附属医院ICU发生MDRO感染的401例患者的临床资料,并根据是否院内死亡分为病死组(98例)和生存组(303例),使用Excel2019和SPSS 27.0对其感染特点和预后影响因素进行总结分析。结果401例ICU患者发生MDRO感染中共检出MDRO 825株,其中革兰氏阴性菌648株(78.5%),前6位分别为:鲍曼不动杆菌(28.0%)、肺炎克雷伯菌(15.2%)、大肠埃希菌(8.7%)、铜绿假单胞菌(6.9%)、洋葱伯克霍尔德菌(6.2%)、嗜麦芽窄食单胞菌(3%);革兰氏阳性菌177株(21.5%),主要为屎肠球菌(6.5%)、金黄色葡萄球菌(4.7%)、表皮葡萄球菌(4.5%)。多因素logistic回归分析结果显示:心脑血管疾病(OR=5.047,95%CI:2.539~10.034,P<0.01)、肺部疾病(OR=3.223,95%CI:1.884~5.512,P<0.01)和机械通气(OR=1.510,95%CI:1.340~15.304,P<0.05)为影响患者预后不良的独立危险因素。结论ICU患者MDRO感染菌株分别以鲍曼不动杆菌和屎肠球菌为主,感染菌株种类较多,心脑血管疾病、肺部疾病和机械通气是影响其预后不良的独立危险因素。

Objective To analyze the characteristics and prognostic influencing factors of multidrug-resistant organism(MDRO)infection in intensive care unit(ICU)patients,and to provide reference for the prevention and treatment of MDRO.Methods The clinical data of 401 patients with MDRO infection admitted to ICU of the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2023 were retrospectively collected.They were divided into mortality group(98 cases)andsurvival group(303 cases)based on whether they died in the hospital.The infection characteristics and prognostic influencing factors were summarized and analyzed using Excel 2019 and SPSS 27.0.Results A total of 401 ICU patients developed MDRO infection,with a total of 825 MDRO strains detected,including 648 of Gram negative bacterium(78.5%).The top six were Acinetobacter baumannii(28.0%),Klebsiella pneumoniae(15.2%),Escherichia coli(8.7%),Pseudomonas aeruginosa(6.9%),Burkholderia cepacia(6.2%),and Stenotrophomonas maltophila(3%);177 strains of Gram positive bacteria(21.5%),mainly including Enterococcus faecium(6.5%),Staphylococcus aureus(4.7%),and Staphylococcus epidermidis(4.5%).Multivariate logistic regression analysis showed that cardiovascular and cerebrovascular diseases(OR=5.047,95%CI:2.539-10.034,P<0.01),pulmonary diseases(OR=3.223,95%CI:1.884-5.512,P<0.01),and mechanical ventilation(OR=1.510,95%CI:1.340-15.304,P<0.05)were independent risk factors affecting poor prognosis in patients.Conclusion The MDRO infection strains in ICU patients are mainly Acinetobacter baumannii and Enterococcus faecium,with a variety of infection strains.Cardiovascular and cerebrovascular diseases,pulmonary diseases,and mechanical ventilation are independent risk factors affecting their poor prognosis.