首页|耐碳青霉烯类肠杆菌合并下呼吸道感染的危险因素及预后分析

耐碳青霉烯类肠杆菌合并下呼吸道感染的危险因素及预后分析

Risk Factors and Prognosis Model Analysis of Carbapenem-resistant Enterobacteriaceae Lower Respiratory Tract Infections

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目的 研究耐碳青霉烯肠杆菌(carbapenem-resistant enterobacteriaceae,CRE)合并下呼吸道感染的危险因素,建立针对该风险的预测模型.方法 选取2021 年2 月至2023 年2 月连云港市第一人民医院206 例CRE下呼吸道感染患者的临床资料,根据28d内是否死亡将入组患者分成生存组136 例和死亡组70 例,分析CRE下呼吸道感染患者的病原菌分布、菌株分类等情况,采用单因素和多元Logistic回归分析预后影响因素并构建风险预测模型,绘制受试者工作特征(re-ceiver operating characteristic,ROC)曲线等检测该风险模型对感染危险因素的预测效能.结果 CRE的检出主要集中在重症医学科(28.65%)、呼吸与危重症医学科(16.02%)等科室.分离到的 CRE 菌株中最常见的是肺炎克雷伯菌(73.12%)、大肠埃希菌(10.85%)和阴沟肠杆菌(7.08%).经过多因素Logistic回归分析发现,急性生理学及慢性健康状况(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、感染性休克、气管切开以及血清白蛋白<30 g/L 是院内 CRE 合并下呼吸道感染的独立危险因素(P<0.05).构建风险预测模型的ROC曲线下面积(area under the curve,AUC)为 0.949(95%CI:0.920～0.979),验证了其具有较高的准确性和较强性能.结论 APACHEⅡ评分、COPD、感染性休克、气管切开和血清白蛋白<30g/L是院内CRE合并下呼吸道感染的独立危险因素,构建风险预测模型能够有效预测患者感染性并发症的风险.
Objective To study the risk factors of carbapenem-resistant enterobacteriaceae(CRE)combined with lower respira-tory tract infection,and establish a prediction model for this risk.Methods The clinical data of 206 patients with CRE lower respira-tory tract infection in the First People's Hospital of Lianyungang City from February 2021 to February 2023 were selected,and the en-rolled patients were divided into survival group(136 cases)and death group(70 cases)according to whether they died within 28 days,and the distribution of pathogenic bacteria and strain classification of patients with CRE lower respiratory tract infection were ana-lyzed.Univariate and multiple Logistic regression were used to analyze the influencing factors of prognosis and construct a risk predic-tion model.Receiver operating characteristic(ROC)curve was drawn to detect the prediction efficiency of this risk model for infection risk factors.Results CRE was detected mainly in the Department of Intensive Care(28.65％)and the Department of Respiratory and Critical Care(16.02％).The most common CRE isolates were Klebsiella pneumoniae(73.12％),Escherichia coli(10.85％),and Enterobacter cloacae(7.08％).Multivariate logistic regression analysis showed that acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,chronic obstructive pulmonary disease(COPD),septic shock,tracheotomy,and serum albumin<30 g/L were independent risk factors for CRE with Lower respiratory tract infection(P<0.05).The area under the curve(AUC)of the risk prediction model is 0.949(95％CI:0.920-0.979),which verifies its high accuracy and strong performance.Conclusion APACHEⅡ score,COPD,septic shock,tracheotomy and serum albumin<30 g/L are independent risk factors of CRE with lower respiratory tract infection in hospital.The risk prediction model can effectively predict the risk of infectious complications in patients.

carbapenem-resistant enterobacteriaceaelower respiratory tract infectionrisk factorsprediction model

邵蔚、圣玉良、王雨豪、张小寒、康秀文、胡蓉

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锦州医科大学连云港市第一人民医院研究生培养基地

徐州医科大学附属连云港市第一人民医院,江苏 连云港 222000

碳青霉烯类耐药肠杆菌科目菌 下呼吸道感染 危险因素 预测模型

国家自然科学基金项目江苏省老年健康科研项目江苏省连云港市卫生科技项目江苏省连云港市卫生计生科技项目江苏省连云港市科技项目江苏省连云港市高新区科技局项目

81300052LKM2023042202104201812SF2213ZD201932

2024

锦州医科大学学报
辽宁医学院

锦州医科大学学报

影响因子：0.802
ISSN：1674-0424
年,卷(期)：2024.45(1)
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