摘要
目的分析山东省重症医学科(ICU)鲍曼不动杆菌血流感染患者预后的危险因素。方法收集2015年1月~2019年12月山东大学齐鲁医院、山东省千佛医院、聊城市人民医院、东营市人民医院、山东省立三院ICU鲍曼不动杆菌血流感染患者125例临床资料,根据预后情况分为存活组(79例)与死亡组(46例)。分析人口学资料、基础疾病、糖皮质激素与免疫抑制剂使用情况、侵袭性操作、病情严重程度、细菌耐药情况,采用单因素、多因素Logistics回归分析的方法分析预后危险因素。结果125例鲍曼不动杆菌血流感染患者中死亡46例,死亡率36.80%。单因素分析表明年龄、合并基础疾病>3种、使用抗菌药物>3种、侵袭性操作、糖皮质激素治疗、APACHEⅡ评分≥20分、住院时间≥30 d均为鲍曼不动杆菌血流感染患者死亡危险因素(P<0.05);多因素Logistic回归分析表明,合并基础疾病>3种(OR=4.012,95%CI:2.366~5.455)、使用抗菌药物>3种(OR=4.365,95%CI:3.152~5.231)、侵袭性操作(OR=2.654,95%CI:2.456~4.785)、糖皮质激素治疗(OR=5.154,95%CI:3.428~5.330)、急性生理学与慢性健康评分Ⅱ(APACHEⅡ)≥20分(OR=6.012,95%CI:3.545~7.364)是鲍曼不动杆菌血流感染患者死亡的独立危险因素。结论ICU鲍曼不动杆菌血流感染患者死亡率较高,与合并基础疾病、使用抗菌药物种类、侵袭性操作、糖皮质激素治疗、APACHEⅡ评分相关,应加强对危险因素的评估,采取针对性的干预措施,以改善鲍曼不动杆菌血流感染患者的预后。
Objective To analyze the prognostic risk factors of patients with bloodstream infection of Acinetobacter baumannii in the Department of Intensive Medicine(ICU)of Shandong Province.Methods From January 2015 to December 2019,125 clinical patients with bloodstream infection from ICU of Baumanii in Qilu Hospital of Shandong University,Qianfo Hospital of Shandong Province,Liaocheng People's Hospital,Dongying City People's Hospital,and Shandong Provincial Third Hospital were collected.The data were divided into survival group(79 cases)and death group(46 cases)according to prognosis.Analyze demographic data,underlying diseases,glucocorticoid and immunosuppressive use,invasive procedures,severity of disease,bacterial resistance,and use univariate and multivariate Logistic regression analysis to analyze prognostic risk factors.Results Of the 125 patients with Acinetobacter baumannii bloodstream infection,46 died,with a mortality of 36.80%.Univariate analysis showed that age,combined underlying diseases>3 types,use of antibacterial drugs>3 types,invasive procedures,glucocorticoid therapy,APACHE II score≥20 points,hospitalization time≥30 d is a risk factor for death of patients with Acinetobacter baumannii bloodstream infection(P<0.05);multivariate Logistic regression analysis showed that the combined underlying diseases were>3(OR=4.012,95%CI:2.366~5.455),and the use of antibacterial drugs>3(OR=4.365,95%CI:3.152~5.231),invasive operation(OR=2.654,95%CI:2.456~4.785),glucocorticoid therapy(OR=5.154,95%CI:3.428~5.330),acute physiology and chronic health scoreⅡ(APACHEⅡ)≥20 points(OR=6.012,95%CI:3.545~7.364)is an independent risk factor for death of patients with Acinetobacter baumannii bloodstream infection.Conclusion ICU Acinetobacter baumannii bloodstream infection patients have a higher mortality rate,which is related to the combination of underlying diseases,the use of antibacterial drugs,invasive procedures,glucocorticoid therapy,and APACHEⅡscore.The assessment of risk factors should be strengthened and targeted interventions should be taken to improve the prognosis of patients with Acinetobacter baumannii blood flow infection.
作者
李冲
赵云
王昊
周蕾
孙楠楠
张玉可
张富祥
姜志明
LI Chong;ZHAO Yun;WANG Hao;ZHOU Lei;SUN Nan-nan;ZHANG Yu-ke;ZHANG Fu-xiang;JIANG Zhi-ming(Second Department of ICU,Qianfoshan Hospital,Jinan 250014,Shandong,China;Second District ICU,Dongying People's Hospital,Dongying 257091,Shandong,China;ICU of Qilu Hospital of Shandong University,Jinan 250117,Shandong,China)
出处
《医学信息》
2020年第13期54-56,68,共4页
Journal of Medical Information
基金
山东省医药卫生科技发展计划项目(编号:2017WS353、2017WS363)。
关键词
重症医学科
鲍曼不动杆菌
血流感染
危险因素
Severe Medicine Department
Acinetobacter baumannii
Blood flow infection
Risk factors
