严重烧伤患者鲍曼不动杆菌血流感染的危险因素及预后分析  

Risk factors and prognosis analysis of Acinetobacter baumannii bloodstream infection in patients with severe burns

作　　者：涂家金[1] 廖武强 刘金晶 涂志鹏 毛远桂 Tu Jiajin;Liao Wuqiang;Liu Jinjing;Tu Zhipeng;Mao Yuangui(Department of Burn Orthopedics and Wound Repair,Ganzhou People′s Hospital,Ganzhou 341000,China;First Clinical Medical College,Jiangxi Medical College of Nanchang University,Nanchang 330006,China;Burn Plastic and Wound Repair Medical Center,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]赣州市人民医院烧伤整形与创面修复科,341000 [2]南昌大学江西医学院第一临床医学院,330006 [3]南昌大学第一附属医院烧伤整形与创面修复医学中心,330006

出　　处：《中华损伤与修复杂志（电子版）》2023年第6期491-497,共7页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨严重烧伤患者鲍曼不动杆菌(Ab)血流感染的危险因素,并对耐碳青霉烯类鲍曼不动杆菌(CRAB)血流感染患者预后情况进行分析,评估感染相关指标对CRAB血流感染严重烧伤患者预后的预测价值。方法选取2014年1月至2021年12月在南昌大学第一附属医院烧伤整形与创面修复医学中心确诊为血流感染的重度及以上烧伤患者212例为研究对象,根据血流感染细菌的不同分为Ab血流感染组(102例)和非Ab血流感染组(110例),对比两组患者临床资料,分析严重烧伤患者Ab血流感染的危险因素。在Ab血流感染组中选取CRAB血流感染患者共98例,根据预后不同分为预后不良组(50例)和预后良好组(48例),对比两组患者临床资料,分析预后不良的相关危险因素,并通过比较两组患者确诊后48 h内的感染相关指标,评估其对CRAB血流感染患者预后的预测价值。结果Ab血流感染组与非Ab血流感染组分析结果显示,合并其他部位Ab感染(OR=1.859,95%CI:1.034~3.344,P=0.038)、合并休克(OR=1.926,95%CI:1.086~3.414,P=0.025)和动脉置管时间(OR=1.028,95%CI:1.002~1.055,P=0.034)是严重烧伤患者Ab血流感染的独立危险因素。预后良好组和预后不良组对比结果显示,长时间机械通气(OR=1.068,95%CI:1.018~1.121,P=0.007)、Ⅲ度烧伤面积大(OR=1.081,95%CI:1.034~1.130,P=0.001)及高龄(OR=1.074,95%CI:1.014~1.137,P=0.015)是CRAB血流感染烧伤患者预后不良的独立影响因素。受试者工作特征(ROC)曲线显示,血小板(PLT)、降钙素原(PCT)和PLT联合PCT预测CRAB血流感染烧伤患者预后不良的曲线下面积分别为0.779(95%CI:0.677~0.880,P<0.001)、0.720(95%CI:0.604~0.836,P=0.001)及0.836(95%CI:0.750~0.923,P<0.001)。结论合并其他部位Ab感染、合并休克和动脉置管时间是严重烧伤患者Ab血流感染的危险因素。长时间机械通气、Ⅲ度烧伤面积大及高龄是CRAB血流感染烧伤患者预后不良的影响因素。PLT和PCT对CRAB血流�Objective To investigate the risk factors for Acinetobacter baumannii(Ab)bloodstream infection in patients with severe burns,analyze the prognosis of patients with carbapenem-resistant Acinetobacter baumannii(CRAB)bloodstream infection,and to assess the predictive value of infection-related indicators for the prognosis of severe burns patients with CRAB bloodstream infection.Methods A total of 212 patients with severe burns and diagnosed with bloodstream infection in the Burn Plastic and Wound Repair Medical Center,the First Affiliated Hospital of Nanchang University from January 2014 to December 2021 were selected for the study,and were divided into the Ab bloodstream infection group(102 cases)and the non-Ab bloodstream infection group(110 cases)according to the different bacteria of bloodstream infection,and the clinical data of the two groups were compared to explore the risk factors for Ab bloodstream infection in patients with severe burns.A total of 98 patients with CRAB bloodstream infection were selected from the Ab bloodstream infection group,and were divided into a poor prognosis group(50 cases)and a good prognosis group(48 cases)according to the prognosis.The risk factors associated with poor prognosis were analyzed by comparing the different clinical data of the two groups,and the predictive value for the prognosis of patients with CRAB bloodstream infection was evaluated by comparing the infection-related indexes of the two groups within 48 hours after diagnosis.Results Analysis of the Ab bloodstream infection group versus the non-Ab bloodstream infection group showed that combined Ab infection at other sites(OR=1.859,95%CI:1.034-3.344,P=0.038),combined shock(OR=1.926,95%CI:1.086-3.414,P=0.025)and duration of arterial cannulation(OR=1.028,95%CI:1.002-1.055,P=0.034)were independent risk factors for Ab bloodstream infection in patients with severe burns.Comparison between the good and poor prognosis groups showed that prolonged mechanical ventilation(OR=1.068,95%CI:1.018-1.121,P=0.007),large full-thick

关 键 词：鲍曼不动杆菌 血流感染 烧伤 耐药性 降钙素原 

分 类 号：R644[医药卫生—外科学]