重症监护病房内血流感染危险因素及预后分析  

Risk factors and prognosis of bloodstream infection in the ICU patients

作　　者：邓医宇[1] 申凤彩 林琼瑜[1,3] 陈朦朦 孙诚[1] 曾红科[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)急危重症医学部,广州510080 [2]汕头大学医学院 [3]南方医科大学

出　　处：《中华急诊医学杂志》2015年第12期1425-1429,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（81271329,81471237）

摘　　要：目的 分析重症加强监护病房（intensive care unit,ICU）内血流感染的危险因素及预后.方法 收集广东省人民医院2012年10月12日至2014年12月1日全部ICU内血培养阳性患者临床数据,进行回顾性分析,比较血培养阳性与阴性患者的生理指标与实验室参数,对发生血流感染的危险因素筛查采用logistic回归分析.在血培养阳性患者中根据临床转归分为生存组与死亡组,比较两组之间的生理指标和实验室参数,用logistic回归分析筛查血流感染患者死亡的危险因素.结果 两年间ICU内发生血培养阳性血流感染患者299例,革兰阳性球菌感染250例,主要溶血葡萄球菌、表皮葡萄球菌、头部葡萄球菌、金黄色葡萄球菌;革兰阴性菌174例,常见致病菌包括鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯氏菌肺炎亚种.单因素分析显示,血培养阳性与阴性患者的高血压（P=0.001）、糖尿病（P=0.01）及冠心病或心力衰竭（P=0.000）、慢性肾功能不全（P=0.000）、机械通气（P=0.000）、住院前静脉使用抗生素（P=0.000）及血浆白蛋白水平（P=0.008）等方面差异具有统计学意义;Logistic多元回归分析显示,糖尿病[OR=2.158, 95％CI（1.230,3.787）,P=0.007]、慢性肾功能不全[OR=13.410,95％CI： （1.715, 104.879）,P=0.013]、住院前静脉使用抗生素[OR=8.375,95％ CI： （5.267,13.317）,P=0.000]为ICU内血培养阳性血流感染的独立危险因素.血培养阳性患者中,与存活组患者相比,死亡组患者年龄较大,患高血压、冠心病或充血性心力衰竭、肿瘤、慢性肾功能不全比例明显增加,机械通气天数明显延长,手术比率及入院前静脉抗生素使用率明显增加,血浆白蛋白水平明显降低.高龄[OR=1.023, 95％ CI：（1.008-1.037）,P=0.002]、机械通气时间延长[OR=1.055,95％ CI：（1.024-1.088）,P=0.000]、低白蛋白水平[OR =0.933, 95％ CI： （0.898-0.971）,P=0.001]为ICU内血培养阳性血流感�Objective To investigate the risk factors and prognosis of blood stream infection in patients of intensive care unit （ICU）.Methods Clinical data of all patients with culture-positive sepsis were collected from all ICUs of Guangdong General Hospital from October 12th, 2012 to December 1st, 2014 for retrospective study.Physiological characteristics and laboratory data were compared between patients with blood culture-positive sepsis group and patients without sepsis of control group.Logistic regression analysis was made to identify the risk factors for blood stream infection.Patients with blood culture-positive sepsis group were further divided into survivor and non-survivor groups according to the clinical outcomes.Physiological and laboratory data were compared between two groups.Logistic regression analysis was also performed to identify the risk factors for mortality.Results There were 299 patients with positive blood culture sepsis admitted in the ICUs in two years.Of them, 250 patients infected with Gram positive cocci including staphylococcus haemolyticus, staphylococcus epidermidis, staphylococcus capitis and staphylococcus aureus accounting for the majority.There were 174 patients infected with Gram negative bacilli including acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniaesubsp.pneumoniae accounting for the majority.A univariate analysis demonstrated that there were significant differences in hypertension （P =0.001）, diabetes （P =0.01）, coronary heart diseases and heart failure （P =0.000）, chronic renal insufficiency （P =0.000）, prolonged mechanical ventilation （P =0.000）, pre-admission intravenous administration of antibiotics （P =0.000）, and hypoalbuminemia （P =0.008） between culture positive group and control group.A logistic regression analysis demonstrated that diabetes [OR =2.158, 95% CI （1.230, 3.787）, P =0.007], chronic renal insufficiency [OR =13.410, 95% CI （1.715, 104.879）, P =0.013], pre-admission intravenous administration of antibiot

关 键 词：描述性回顾性研究 LOGISTIC回归分析 血流感染 血培养阳性脓毒症 重症加强病房 危险因素 预后 病死率 

分 类 号：R197.323[医药卫生—卫生事业管理]