肝硬化失代偿期患者合并多重耐药菌感染的危险因素分析  

Analysis of risk factors for multidrug-resistant bacterial infection in patients with decompensated cirrhosis

作　　者：钱晨莹[1] 闫文君 黄燕[1] 赵志[1] Qian Chenying;Yan Wenjun;Huang Yan;Zhao Zhi(ICU,Department of Infection,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;School of Nursing,Soochow University,Suzhou 215021,China)

机构地区：[1]苏州大学附属第一医院感染科ICU,江苏苏州215006 [2]苏州大学护理学院,江苏苏州215021

出　　处：《临床荟萃》2025年第2期143-146,共4页Clinical Focus

基　　金：苏州大学附属第一医院2021年“周氏”课题基金——肝硬化失代偿期患者并发多重耐药菌感染的危险因素研究及护理对策探讨(HLYJ-Z-202108)。

摘　　要：目的探讨肝硬化失代偿期患者并发多重耐药菌感染的危险因素。方法对2017年1月至2020年12月在本院住院的133例肝硬化失代偿期患者的临床资料进行回顾性队列研究,其中33例发生多重耐药菌感染者设为感染组,其余100例未发生多重耐药菌感染者设为非感染组。收集所有可能引起患者发生多重耐药菌感染的临床特征及生化指标,并采用单因素和多因素logistic多元回归分析法分析肝硬化失代偿期发生多重耐药菌感染的危险因素。结果在133例研究对象中,发生多重耐药菌感染的共33例,占比24.81%,其中感染耐碳青霉烯类鲍曼不动杆菌(CR-AB)为16例,占比最多。单因素分析显示患者的住院时间、有无使用机械通气、有无入住ICU、有无使用激素、有无侵入性操作、是否合并脓毒症休克及白蛋白水平等因素与多重耐药菌(multidrug resistance bacteria,MDRO)的发生有关,差异均有统计学意义(P<0.05)。经logistic回归分析得出住院时长≥10 d、合并脓毒症性休克是影响并发多重耐药菌感染的独立危险因素。结论失代偿期肝硬化患者若住院时长≥10 d或合并脓毒症休克时则并发多重耐药菌感染的风险较大,临床实践中应加强评估,早期采取针对性干预措施。Objective To investigate the risk factors for concurrent multidrug-resistant bacterial infections in patients with decompensated cirrhosis.Methods A retrospective cohort study was conducted on the clinical data of 133 patients with decompensated cirrhosis hospitalized from January 2017 to December 2020,in which 33 cases who developed multidrug-resistant bacterial infections were set up as the infected group,and the remaining 100 cases who did not develop multidrug-resistant bacterial infections were set up as the non-infected group.All the clinical features and biochemical indicators that might cause multi-drug resistant bacteria infection were collected,and the risk factors for the development of multi-drug resistant bacteria infection in decompensated cirrhosis patients were analyzed by univariate and multivariate Logistic regression analyses.Results Among the 133 study subjects,33(24.81%)had multidrug-resistant bacterial infections,and the dominant(16 cases)was infected with Carbapenem-resistant Acinetobacter baumannii(CRAB).Univariate analysis showed that the length of stay,mechanical ventilation,ICU admission,hormone use,invasive operation,comorbid septic shock,and albumin level were significantly associated with multidrug-resistant organisms(MDRO)(P<0.05).Multivariate logistic regression analysis further concluded that the length of stay≥10 d and the comorbid septic shock were independent risk factors for multidrug-resistant bacterial infections.Conclusion Patients with decompensated cirrhosis who are hospitalized for≥10 d or in septic shock are at a greater risk of multidrug-resistant bacterial infections,and they should be evaluated for early interventions in clinical practice.

关 键 词：肝硬化 失代偿期 多重耐药菌 感染 危险因素 

分 类 号：R575.2[医药卫生—消化系统]