急诊重症患者医院感染的危险因素与预测模型构建  

Risk factors for nosocomial infection in critical patients of emergency department and establishment of prediction model

作　　者：朱琳[1] 黄慧[1] 沈艳[1] 刘小琴[1] 顾玉慧[2] 虞亚蔚 ZHU Lin;HUANG Hui;SHEN Yan;LIU Xiao-qin;GU Yu-hui;YU Ya-wei(Affiliated Hospital of Nantong University,Nantong,Jiangsu 22600l,China)

机构地区：[1]南通大学附属医院急诊科,江苏南通226001 [2]南通大学附属医院门诊内镜中心,江苏南通226001

出　　处：《中华医院感染学杂志》2024年第10期1579-1583,共5页Chinese Journal of Nosocomiology

基　　金：江苏省医院协会医院管理创新专项研究课题(JSYGY-2-2021-JZ3)。

摘　　要：目的探究急诊重症患者医院感染的危险因素,并构建预测模型。方法回顾性统计南通大学附属医院2020年2月-2023年2月收治的343例急诊重症患者的临床资料,根据是否发生医院感染,将其分为感染组(51例)和非感染组(292例)。统计医院感染患者感染部位、病原菌分布特点;通过Logistic回归分析法分析急诊重症患者发生医院感染的危险因素并构建预测模型。结果343例急诊重症患者医院感染发生率为14.87%(51/343);医院感染部位以下呼吸道感染占比最高,占比为33.33%,手术切口和胃肠道感染占比次之,占比均为15.69%;51例急诊重症医院感染患者共检出病原菌59株,其中革兰阴性菌33株(55.93%),革兰阳性菌19株(32.20%),真菌7株(11.86%);Logistic分析结果显示,应用大量抗菌药物或激素、有多病变部位、有侵入性操作、有气管插管或气管切开、有留置尿管是急诊重症患者医院感染发生的危险因素(OR=2.549、3.274、2.050、2.802、2.230,P<0.05),按照诊断概率Logit(P)绘制急诊重症患者医院感染的ROC曲线,当Logit(P)>0.09时,AUC值为0.705,95%CI为0.632~0.777,模型诊断敏感度为88.26%,特异度为70.51%。结论下呼吸道感染为急诊重症患者中占比较高的感染类型之一,以革兰阴性菌为主要感染病原菌,应用大量抗菌药物或激素、多病变部位、侵入性操作、气管插管或气管切开、留置尿管与急诊重症患者医院感染发生密切相关,据此建立的预测模型预测急诊重症患者医院感染价值高。OBJECTIVE To explore the risk factors for nosocomial infection in the critical patients of emergency department and establish the prediction model.METHODS The clinical data were collected from 343 critical patients who were treated in emergency department of the Affiliated Hospital of Nantong University from Feb 2020 to Feb 2023 and were statistically analyzed.The enrolled patients were divided into the infection group with 51 cases and the non-infection group with 292 cases according to the status of nosocomial infection.The infection sites and pathogens were statistically analyzed,logistic regression analysis was performed for the risk factors for the nosocomial infection in the critical patients,and the prediction model was established.RESULTS The incidence of nosocomial infection was 14.87%(51/343)among the 343 critical patients of emergency department.Among the patients with nosocomial infection,the patients with lower respiratory tract infection accounted for 33.33%,the patients with surgical incision infection 15.69%,the patients with gastrointestinal tract infection 15.69%.Totally 59 strains of pathogens were isolated from the 51 critical patients of emergency department,33(55.93%)of which were gram-negative bacteria,19(32.20%)were gram-positive bacteria,and 7(11.86%)were fungi.The result of logistic analysis showed that excessive use of antibiotics or hormones,multiple sites of lesions,invasive operation,endotracheal intonation or tracheotomy and urinary catheter indwelling were the risk factors for the nosocomial infection in the critical patients of emergency department(OR=2.549,3.274,2.050,2.802,2.230,P<0.05).ROC curves were drawn for the patients with nosocomial infection based on the diagnostic probability Logit(P),when Logit(P)was more than 0.09,AUC was 0.705,95%CI was 0.632-0.777;the sensitivity of the model was 88.26%in diagnosis,with the specificity 70.51%.CONCLUSION The patients with lower respiratory tract infection are dominant among the critical patients with nosocomial infection in the emer

关 键 词：医院感染 急诊 重症 病原菌 危险因素 预测模型 

分 类 号：R459.7[医药卫生—急诊医学]