急诊血流感染患者发生耐碳青霉稀类革兰阴性杆菌血流感染的影响因素分析  

Analysis of influencing factors of Carbapenem-resistant Gram-negative bacilli in emergency patients with bloodstream infection

作　　者：崔北辰 张明清 王海英 Cui Beichen;Zhang Mingqing;Wang Haiying(Department of Emergency,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院急诊科,100035

出　　处：《北京医学》2024年第10期831-836,共6页Beijing Medical Journal

摘　　要：目的探讨急诊血流感染患者发生耐碳青霉烯类革兰阴性杆菌(carbapenem-resistant gram-negative bacilli,CR GNB)血流感染的影响因素。方法选取2015—2019年首都医科大学附属北京积水潭医院急诊血流感染患者228例,根据血培养结果分为CR GNB组(60例)和Non-CR GNB组(168例),采用倾向性评分匹配(propensity score matching,PSM)1∶2的比例进行匹配,采用条件logistic回归分析急诊血流感染患者发生CR GNB血流感染的影响因素。结果228例患者中,男125例、女103例,年龄17~99岁,中位年龄为77岁,经PSM成功匹配59对。条件logistic回归分析结果显示,就诊前30 d内使用机械通气(OR=4.759,95%CI:1.184~19.127,P=0.028)及碳青霉烯类抗生素(OR=5.706,95%CI:1.974~16.493,P=0.001)、就诊前治疗时间越长(OR=1.050,95%CI:1.010~1.092,P=0.019)的急诊血流感染患者发生CR GNB血流感染的风险越高。结论就诊前30 d内使用机械通气及碳青霉烯类抗生素、就诊前治疗时间越长是急诊血流感染患者发生CR GNB血流感染的独立危险因素,应减少该类患者抗生素的错误选择,急诊诊治时需更谨慎合理、个体化的使用抗生素,以改善预后。Objective To explore the influencing factors of carbapenem-resistant gram-negative bacilli(CR GNB)bloodstream infection in emergency patients with bloodstream infection.Methods A total of 228 patients with Gram-negative bacteria bloodstream infection in Beijing Jishuitan Hospital,Capital Medical University from 2015 to 2019 were selected,and were divided into CR GNB group(60 cases)and Non-CR GNB group(168 cases)according to the blood culture results.The ratio of propensity score matching(PSM)was 1:2,and the influencing factors of CR GNB blood flow infection in emergency patients were analyzed by conditional logistic regression.Results Among the 228 patients,there were 125 males and 103 females,aged from 17 to 99 years,with a median age of 77 years,and 59 pairs were successfully matched by PSM.A total of 228 GNB patients were included,including 60 cases in the CR GNB group and 168 cases in the non-CR GNB group.Conditional logistic regression analysis showed that mechanical ventilation within 30 days(OR=4.759,95%CI:1.184-19.127,P=0.028)and carbapenem antibiotics(OR=5.706,95%CI:1.974-16.493,P=0.001),the longer the treatment time before treatment(OR=1.050,95%CI:1.010-1.092,P=0.019),the higher the risk of CR GNB bloodstream infection.Conclusions Mechanical ventilation within 30 days,treated by carbapenem antibiotics within 30 days,and the longer treatment time before treatment are independent risk factors for CR GNB bloodstream infection in emergency patients.The wrong choice of antibiotics should be reduced,and antibiotics should be used more carefully,reasonably and individually in emergency diagnosis and treatment to improve the prognosis..

关 键 词：耐碳青霉烯类革兰阴性杆菌 血流感染 急诊 倾向性评分匹配 

分 类 号：R446.5[医药卫生—诊断学]