产超广谱β-内酰胺酶肠杆菌血流感染患者不良预后危险因素分析  

Risk factors of poor prognosis in patients with bloodstream infection caused by extended-spectrum β-lactamase producing enterobacters

作　　者：王云鹏 赵继京 张伟星 陈澍 吴芬[1] 傅裕民 邹丽珍 邹志浩 章嘉麟 WANG Yunpeng;ZHAO Jijing;ZHANG Weixing;CHEN Shu;WU Fen;FU Yumin;ZOU Lizhen;ZOU Zhihao;ZHANG Jialin(Department of Respiratory,the First People’s Hospital of Jiande,Hangzhou 311600,Zhejiang,China)

机构地区：[1]建德市第一人民医院呼吸内科,浙江杭州311600

出　　处：《中国现代医生》2024年第32期43-46,共4页China Modern Doctor

基　　金：浙江省建德市科技计划项目(2023SJZX31)。

摘　　要：目的通过分析产超广谱β-内酰胺酶肠杆菌(extended-spectrum β-lactamase producing enterobacterales,ESBL-E)血流感染患者不良预后的危险因素,构建列线图预测模型,为临床诊治提供帮助。方法回顾性分析建德市第一人民医院收治的血培养结果为ESBL-E血流感染235例患者的临床资料,根据患者预后分为存活组(n=211)和死亡组(n=24)。采用多因素Logistic回归分析筛选预后不良的独立危险因素,建立列线图并对其进行验证。结果合并休克、呼吸衰竭、糖尿病和白血病、入住重症监护室、低蛋白血症、白细胞计数升高或降低、血小板计数减少的ESBL-E血流感染患者死亡率更高(P<0.05);多因素Logistic回归分析结果表明合并休克、呼吸衰竭、白血病是ESBL-E血流感染患者死亡的独立危险因素。结论通过建立ESBL-E血流感染患者不良预后危险因素的列线图预测模型,为临床医生早期判断患者不良预后提供帮助,早期采取干预措施,降低患者病死率。Objective To analyze the risk factors of poor prognosis in patients with extended-spectrum β-lactamase producing enterobacterales(ESBL-E)bloodstream infection,and establish a nomogram prediction model to provide help for clinical diagnosis and treatment.Methods A total of 235 patients with ESBL-E bloodstream infection were collected from the First People’s Hospital of Jiande City.According to their prognosis,the patients were divided into survival group(n=211)and death group(n=224).The clinical data of the patients were collected,and the independent risk factors of poor prognosis were screened by multivariate Logistic regression analysis.The nomogram was established and verified.Results The mortality of ESBL-E bloodstream infection patients with shock,respiratory failure,diabetes and leukemia,ICU admission,hypoproteinemia,increased or decreased white blood cells,and thrombocytopenia was higher(P<0.05).Multivariate Logistic regression analysis showed that combined shock,respiratory failure and leukemia were independent risk factors for death from ESBL-E bloodstream infection.Conclusion The nomogram prediction model of adverse prognostic risk factors in patients with ESBL-E bloodstream infection can provide help for clinicians to judge the poor prognosis in the early stage,and it is of reference significance to take early intervention measures to reduce the mortality of patients.

关 键 词：产超广谱β-内酰胺酶肠杆菌 血流感染 列线图 

分 类 号：R515[医药卫生—内科学]