重症监护病房血流感染的危险因素及预后分析
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摘要
目的探讨重症监护病房(ICU)血流感染的危险因素及影响血流感染预后的相关因素分析。方法回顾性分析2014年10月-2017年10月河北衡水市哈励逊国际和平医院ICU诊断为血流感染的住院患者,同时选取210例血培养阴性患者资料,比较血培养阳性与阴性患者的生理指标与实验室参数,采用多因素logistic回归分析发生血流感染的危险因素。将189例血流感染患者按血培养采集后30 d内预后分为存活组(121例)和死亡组(68例),分析影响血流感染30d预后的相关危险因素。结果 3年间ICU发生血流感染189例,革兰阴性杆菌118例,革兰阳性球菌65例,真菌6例。单因素分析显示,先前接受碳青霉烯类或第三代头孢菌素治疗、中心静脉置管、住院天数≥2周、机械通气为发生血流感染的危险因素,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,之前接受碳青霉烯类或第三代头孢菌素治疗(OR=20.15)、中心静脉置管(OR=25.34)、机械通气(OR=18.26)为ICU血流感染的独立危险因素。单因素分析显示,应用碳青霉烯类药物或第三代头孢菌素治疗、混合感染或感染性休克、多重耐药(MDR)菌感染和高急性生理与慢性健康评分(APACHEⅡ评分)是影响血流感染30d预后危险因素,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,混合感染或感染性休克(OR=15.30)、MDR菌感染(OR=10.75)和高APACHEⅡ评分(OR=13.70)为影响血流感染30 d预后的独立危险因素。结论之前接受碳青霉烯类或第三代头孢菌素治疗、中心静脉置管、机械通气是ICU血流感染的独立危险因素,混合感染或感染性休克、MDR菌感染和高APACHEⅡ评分是影响血流感染30d预后的独立危险因素。
Objective To investigate the risk factors and prognostic factors of bloodstream infection in intensive care unit(ICU). Methods The data of patients with bloodstream infection in ICU of Harrison International Peace Hospital from October 2014 to October 2017 were retrospectively analyzed and 210 patients with negative blood culture were selected. The physiological and laboratory parameters were compared between patients with positive blood culture and those with negative blood culture. Multivariate logistic regression analysis was used to screen the risk factors of bloodstream infection. Overall, 189 patients with bloodstream infection were classified into survival group(n=121) and death group(n=68) according to the survival status within 30 days after blood culture. The risk factors related to 30-day patient outcome following bloodstream infection were analyzed. Results A total of 189 cases of bloodstream infection were identified in the ICU during the 3-year period, including 118 cases due to gram-negative bacilli, 65 cases caused by gram-positive cocci, and 6 cases due to fungi. Univariate analysis showed that prior use of carbapenem or third generation cephalosporins, central venous catheterization, length of hospital stay≥2 weeks, and mechanical ventilation were the risk factors of bloodstream infection(P<0.05). Multivariate logistic regression analysis showed that prior use of carbapenems or third-generation cephalosporins(OR=20.15), central venous catheterization(OR=25.34), and mechanical ventilation(OR=18.26) were independent risk factors for bloodstream infection in ICU patients. Univariate analysis showed that prior use of carbapenem or third generation cephalosporins, mixed infection or septic shock, multi-drug resistant bacterial infection, and high APACHE Ⅱ(acute physiological and chronic health evaluation system Ⅱ) score were significant risk factors for 30-day mortality following bloodstream infection(P<0.05). Multivariate logistic regression analysis showed mixed infection or septic shock(OR=15.30), multi-drug resistant bacterial infection(OR=10.75) and high APACHE Ⅱ score(OR=13.70) were independent risk factors for 30-day mortality following bloodstream infection. Conclusions Prior use of carbapenem or third generation cephalosporins, central venous catheterization and mechanical ventilation are independent risk factors for bloodstream infection in ICU patients. Mixed infection or septic shock, multi-drug resistant bacterial infection, and high APACHE Ⅱ score are independent risk factors for 30-day mortality following bloodstream infection.
Objective To investigate the risk factors and prognostic factors of bloodstream infection in intensive care unit(ICU). Methods The data of patients with bloodstream infection in ICU of Harrison International Peace Hospital from October 2014 to October 2017 were retrospectively analyzed and 210 patients with negative blood culture were selected. The physiological and laboratory parameters were compared between patients with positive blood culture and those with negative blood culture. Multivariate logistic regression analysis was used to screen the risk factors of bloodstream infection. Overall, 189 patients with bloodstream infection were classified into survival group(n=121) and death group(n=68) according to the survival status within 30 days after blood culture. The risk factors related to 30-day patient outcome following bloodstream infection were analyzed. Results A total of 189 cases of bloodstream infection were identified in the ICU during the 3-year period, including 118 cases due to gram-negative bacilli, 65 cases caused by gram-positive cocci, and 6 cases due to fungi. Univariate analysis showed that prior use of carbapenem or third generation cephalosporins, central venous catheterization, length of hospital stay≥2 weeks, and mechanical ventilation were the risk factors of bloodstream infection(P<0.05). Multivariate logistic regression analysis showed that prior use of carbapenems or third-generation cephalosporins(OR=20.15), central venous catheterization(OR=25.34), and mechanical ventilation(OR=18.26) were independent risk factors for bloodstream infection in ICU patients. Univariate analysis showed that prior use of carbapenem or third generation cephalosporins, mixed infection or septic shock, multi-drug resistant bacterial infection, and high APACHE Ⅱ(acute physiological and chronic health evaluation system Ⅱ) score were significant risk factors for 30-day mortality following bloodstream infection(P<0.05). Multivariate logistic regression analysis showed mixed infection or septic shock(OR=15.30), multi-drug resistant bacterial infection(OR=10.75) and high APACHE Ⅱ score(OR=13.70) were independent risk factors for 30-day mortality following bloodstream infection. Conclusions Prior use of carbapenem or third generation cephalosporins, central venous catheterization and mechanical ventilation are independent risk factors for bloodstream infection in ICU patients. Mixed infection or septic shock, multi-drug resistant bacterial infection, and high APACHE Ⅱ score are independent risk factors for 30-day mortality following bloodstream infection.
引文
[1]蒋志华,廖喻,王桥生,等.ICU血液透析导管相关血流感染危险因素分析与干预[J].中华医院感染学杂志,2016,26(16):3824-3826.
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[9]YOSHIDA J,ISHIMARU T,KIKUCHI T,et al.Assocition between risk of bloodstream infection and duration of use of totally implantabie accesss ports and central lines:a 24-momnth study[J].Am J Infect Control,2011,39(7):e39-43.
[10]HAJJEJ Z,NASRI M,SELLAMI W,et al.Incidence,risk factors and microbiology of central vascular catheterrelated bloodstream infection in an intensive care unit[J].J Infect Chemother,2014,20(3):163-168.
[11]JIA L,YU H,LU J,et al.Epidemiological characteristics and risk factors for patients with catheter-related bloodstream infections in intensive care unit[J].Zhonghua Yi Xue Za Zhi,2015,95(9):654-658.
[12]TAO F,JIANG R,CHEN Y,et al.Risk factors for early onset of catheter-related bloodstream infection in an intensive care unit in China:a retrospective study[J].Med Sci Monit,2015,21:550-556..
[13]邓医宇,申凤彩,林琼瑜,等.重症监护病房内血流感染危险因素及预后分析[J].中华急诊医学杂志,2015,24(12):1425-1429.
[14]SHANKAR-HARI M,PHILLIPS G S,LEVY M L,et al.Developing a new definition and assessing new criteria for septic shock:for the third international consensus definitions for sepsis and sepsis shock(sepsis-3)[J].JAMA,2016,315(8):775-787.
[15]魏锋,洪志敏,董海涛,等.ICU重症脓毒症的流行病学特点及预后影响因素分析[J].中华医院感染学杂志,2018,28(10):1469-1471,1484.
[16]陈坤,单红卫.常用危重评分在脓毒症预后评价中的应用[J].中国急救医学,2014,34(8):679-682.
[17]DE FREITAS E R.Profile and severity of the patients of intensive Care units:prospective application of the APACHE IIindex[J].Rev Lat Am Enfermagem,2010,18(3):317-323.
[2]PROWLE J R,ECHEVERRI J E,LIGABO E V,et al.Acquire blood stream infection in the intensive care unit:incidence and attributable mortality[J].Crit Care,2011,15(2):R100.
[3]PHUA J,NGERNG W,SEE K,et al.Charecteristics and outcomes of culture-negative versus culture-positive severe sepsis[J].Crit Care,2013,17(5):R202.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[6]韩静静,邓艳萍,高鑫,等.ICU中革兰阴性菌血流感染的危险因素分析[J].重庆医学,2016,45(12):1638-1640.
[7]KOUPETORI M,RETSAS T,ANTONAKOS N,et al.Blood stream infections and sepsis in Greece:over-time change of epidemiology and impact of deescalation on final outcome[J].BMC Infect Dis,2014,14:272.
[8]斯一夫,姜建平,闫广玲,等.ICU患者中心静脉导管相关性感染病原菌与耐药性分析[J].中华医院感染学杂志,2015,25(6):1331-1333.
[9]YOSHIDA J,ISHIMARU T,KIKUCHI T,et al.Assocition between risk of bloodstream infection and duration of use of totally implantabie accesss ports and central lines:a 24-momnth study[J].Am J Infect Control,2011,39(7):e39-43.
[10]HAJJEJ Z,NASRI M,SELLAMI W,et al.Incidence,risk factors and microbiology of central vascular catheterrelated bloodstream infection in an intensive care unit[J].J Infect Chemother,2014,20(3):163-168.
[11]JIA L,YU H,LU J,et al.Epidemiological characteristics and risk factors for patients with catheter-related bloodstream infections in intensive care unit[J].Zhonghua Yi Xue Za Zhi,2015,95(9):654-658.
[12]TAO F,JIANG R,CHEN Y,et al.Risk factors for early onset of catheter-related bloodstream infection in an intensive care unit in China:a retrospective study[J].Med Sci Monit,2015,21:550-556..
[13]邓医宇,申凤彩,林琼瑜,等.重症监护病房内血流感染危险因素及预后分析[J].中华急诊医学杂志,2015,24(12):1425-1429.
[14]SHANKAR-HARI M,PHILLIPS G S,LEVY M L,et al.Developing a new definition and assessing new criteria for septic shock:for the third international consensus definitions for sepsis and sepsis shock(sepsis-3)[J].JAMA,2016,315(8):775-787.
[15]魏锋,洪志敏,董海涛,等.ICU重症脓毒症的流行病学特点及预后影响因素分析[J].中华医院感染学杂志,2018,28(10):1469-1471,1484.
[16]陈坤,单红卫.常用危重评分在脓毒症预后评价中的应用[J].中国急救医学,2014,34(8):679-682.
[17]DE FREITAS E R.Profile and severity of the patients of intensive Care units:prospective application of the APACHE IIindex[J].Rev Lat Am Enfermagem,2010,18(3):317-323.
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