危重症腹腔感染患者中屎肠球菌感染的危险因素分析  

Risk factors for Enterococcus faecium infections in patients with critical abdominal infections

作　　者：罗晶[1] 解翠红[1] Luo Jing;Xie Cuihong(Department of Critical Care Medicine,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院重症医学科,武汉430030

出　　处：《中华危重症医学杂志(电子版)》2024年第6期452-457,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的初步分析屎肠球菌感染危险因素及耐药情况,为危重症腹腔感染患者经验覆盖屎肠球菌提供临床依据。方法回顾性分析华中科技大学同济医学院附属同济医院重症医学科2016年1月至2021年8月三个院区ICU收治的112例危重腹腔感染患者的临床资料及病原分布,根据是否感染屎肠球菌将其分为感染组(24例)和非感染组(88例),对可能与屎肠球菌感染相关的因素进行分析。结果112例腹腔感染患者通过腹腔引流和/或血培养得到非重复病原株188株,其中屎肠球菌24株(12.8%),未培养出耐万古霉素屎肠球菌(VREfm)。两组患者性别、年龄、ICU住院时长、序贯器官衰竭评估(SOFA)评分≥13分、急性病生理学和长期健康评价(APACHE)Ⅱ评分≥25分、合并症及预后情况比较,差异均无统计学意义(P均>0.05)。多因素逻辑回归分析结果显示,肠道机械屏障破坏[比值比(OR)=3.314,95%置信区间(CI)(1.147,9.573),P=0.027]是危重症腹腔感染患者屎肠球菌感染的独立危险因素。结论与以往研究不同的是,ICU三代头孢和碳青霉烯药物使用与屎肠球感染无关,且未促进VREfm感染,肠道机械屏障破坏是危重症腹腔感染患者屎肠球菌感染的独立危险因素。Objective To preliminarily analyze the risk factors of Enterococcus faecium infections and drug resistance of Enterococcus faecium,and to provide clinical basis for empirical coverage of Enterococcus faecium in patients with critical abdominal infections.Methods A retrospective analysis was performed on 112 patients with critical abdominal infections in the Department of Critical Care Medicine in three districts of Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from January 2016 to August 2021.According to whether they were infected with Enterococcus faecium,patients were divided into an infection group(24 cases)and a non-infection group(88 cases),and factors that may be associated with Enterococcus faecium infections were statistically analyzed.Results A total of 112 patients with intra-abdominal infections were studied,yielding 188 non-repetitive pathogenic strains through abdominal drainage and/or blood cultures,including 24 strains of Enterococcus faecium(12.8%).No vancomycin-resistant Enterococcus faecium(VREfm)was isolated.Comparisons between the two groups showed no statistically significant differences in terms of sex,age,ICU length of stay,sequential organ failure assessment scores≥13,acute physiology and chronic health evaluation II scores≥25,comorbidities,and prognosis(all P>0.05).Multivariate logistic regression analysis indicated that intestinal mechanical barrier disruption[odds ratio=3.314,95%confidence interval(1.147,9.573),P=0.027]was an independent risk factor for Enterococcus faecium infections in critically ill patients with intraabdominal infections.Conclusions Unlike previous studies,the use of third-generation cephalosporins and carbapenems in the ICU is not associated with Enterococcus faecium infections and does not promote VREfm infections.Intestinal mechanical barrier damage is an independent risk factor for Enterococcus faecium infections in patients with critical intraabdominal infections.

关 键 词：腹腔感染 屎肠球 脓毒性休克 

分 类 号：R47[医药卫生—护理学]