烧伤患者医院感染的流行病学特点及风险预测模型的构建与评价  

Epidemiological characteristics and the establishment and evaluation of a risk prediction model for nosocomial infection in burn patients

作　　者：王华 赵朋 孙丹 武星[3] 袁琴芳 王克伟 Wang Hua;Zhao Peng;Sun Dan;Wu Xing;Yuan Qinfang;Wang Kewei(Institute of Integrated Chinese and Western Medicine,Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Burns,Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Hospital Infection,Affiliated Hospital of Jiangnan University,Wuxi 214122,China)

机构地区：[1]江南大学附属医院中西医结合研究所,无锡214122 [2]江南大学附属医院烧伤科,无锡214122 [3]江南大学附属医院医院感染科,无锡214122

出　　处：《中华烧伤与创面修复杂志》2022年第12期1170-1178,共9页Chinese Journal of Burns And Wounds

基　　金：无锡市“双百”中青年医疗卫生后备拔尖人才基金(HB2020040);无锡市卫生健康委2020年度重大项目(Z202007)。

摘　　要：目的了解烧伤患者医院感染的流行病学特点, 探寻烧伤患者发生医院感染的独立危险因素, 以此构建风险预测模型并分析其预测价值。方法采用回顾性病例系列研究方法。2016年5月—2019年12月, 江南大学附属医院烧伤科收治3 475例符合入选标准的烧伤患者, 其中男2 290例、女1 185例, 年龄1~94岁, 统计其医院感染发生率、病原菌检出部位与具体构成。将患者按照大约7∶3的比例在R 4.1.3统计软件中随机分为训练组(2 434例)和验证组(1 041例), 比较2组患者入院时性别、年龄、烧伤总面积、合并Ⅲ度烧伤/吸入性损伤/休克/糖尿病情况以及入住重症监护病房(ICU)情况、行中心静脉置管/气管插管/留置导尿管/手术情况、医院感染情况、抗生素使用天数、住院天数。根据是否发生医院感染, 将患者分为医院感染组(102例)和未医院感染组(3 373例), 统计2组患者前述除医院感染情况外的资料以及入院季节、抗生素使用种类。对前述数据行独立样本t检验、χ^(2)检验、Mann-WhitneyU检验等单因素分析, 将医院感染组与未医院感染组比较差异有统计学意义的指标作为自变量纳入多因素logistic回归分析, 筛选3 475例烧伤患者发生医院感染的独立危险因素。在独立危险因素与重要临床特征基础上, 构建训练组烧伤患者发生医院感染风险的列线图预测模型。在训练组和验证组中, 绘制预测模型预测医院感染的受试者操作特征(ROC)曲线, 计算曲线下面积;绘制校准曲线, 评估预测模型预测结果与实际发生情况的符合度;绘制临床决策曲线, 评估预测模型的临床效用。结果该研究纳入患者医院感染发生率为2.94%(102/3 475);共从212个标本中检出病原菌, 以创面(78例, 占36.79%)和血液(64例, 占30.19%)标本为主;共检出病原菌250株, 以革兰阴性菌(153株, 占61.20%)为主。训练组和验证组患者所有临床特征情况Objective To find the epidemiological characteristics of nosocomial infection in burn patients,to establish a risk prediction model for nosocomial infection in burn patients based on the screened independent risk factors of the infection,and to analyze its predictive value.Methods A retrospective case series study was conducted.From May 2016 to December 2019,3475 burn patients who were admitted to the Department of Burns of Affiliated Hospital of Jiangnan University met the inclusion criteria,including 2290 males and 1185 females,aged from 1 to 94 years.The incidence of nosocomial infection,the detection site and specific composition of pathogenic bacteria were counted.The patients were randomly divided into training group(2434 cases)and verification group(1041 cases)in R 4.1.3 statistic software with a ratio of about 7∶3.Factors including gender,age,total burn area,combination of full-thickness burn/inhalation injury/shock/diabetes on admission,admission to intensive care unit(ICU),status of central venous catheterization/endotracheal intubation/urethral catheter indwelling/surgery,nosocomial infection status,days of antibiotic use,and days of hospital stay of patients were compared between the two groups.According to the occurrence of nosocomial infection,the patients were divided into nosocomial infection group(102 cases)and non-nosocomial infection group(3373 cases),and in addition to the aforementioned data,non-nosocomial infection related data,the season of admission and types of antibiotics used were compared between the two groups.The above-mentioned data were statistically analyzed with one-way analysis of independent sample t test,chi-square test,and Mann-Whitney U test,and the indicators with statistically significant differences between nosocomial infection group and non-nosocomial infection group were included as variables in multivariate logistic regression analysis to screen independent risk factors for the development of nosocomial infection in 3475 burn patients.On the basis of independent risk

关 键 词：烧伤 交叉感染 危险因素 回归分析 列线图 

分 类 号：R181.3[医药卫生—流行病学] R644[医药卫生—公共卫生与预防医学]