摘要
目的 探究医院耐碳青霉素烯类鲍曼不动杆菌血流感染所致死亡预测模型.方法 选择2019年1月至2023年3月海南医学院第一附属医院收治159例耐碳青霉烯类鲍曼不动杆菌血流感染患者相关资料进行回顾性分析.依据患者感染后30 d生存情况分为死亡组(n=47)与生存组(n=112).收集患者各项临床资料,进行菌株鉴定与药敏试验.采用多元Logistic回归分析患者死亡影响因素,并以此构建死亡发生预测模型,采用受试者操作特征(ROC)曲线分析预测模型预测效果.结果 159例患者分离获得菌株165株,基本为多重耐药菌,其中对哌拉西林/他唑巴坦及亚胺培南耐药性达到100％,而对环丙沙星、美罗培南、头孢吡肟、妥布霉素、哌拉西林/他唑巴坦、左氧氟沙星和替卡西林/克拉维酸的耐药性分别为90.91％、89.09％、80.00％、75.15％、71.52％、64.24％、56.97％,而对米洛环、替加环素素耐药性较低,分别为12.73％与9.70％.单因素与多元Logistic回归分析显示,APACHE Ⅱ评分、脓毒性休克、其他病原体感染、降钙素原、抗菌药物应用种类＞3种是死亡发生影响因素(P＜0.05).以多元Logistic回归分析结果为基础构建风险预测模型,模型为log P=3.526+APACHEⅡ评分×0.398+脓毒性休克×0.413+其他病原体感染×0.407+降钙素原×0.529+抗菌药物应用种类＞3种×0.351,Hosmer-Lemeshow检验显示x2=5.336,P=0.219,ROC曲线显示曲线下面积为0.826(95％CI:0.716～0.887),最佳临界值为0.712,敏感度、特异度以及准确率分别为86.25％、80.56％及79.35.结论 APACHE Ⅱ评分、脓毒性休克、其他病原体感染等是医院耐碳青霉素烯类鲍曼不动杆菌血流感染所致死亡影响因素,据此构建风险预测模型有一定价值.
Abstract
Objective To explore the prediction model of death due to bloodstream infection of carbpenicillin-resistant Acinetobacter baumannii in hospital.Methods The relevant data of 159 patients with carbapenem-resistant Acinetobacter baumannii bloodstream infection ad-mitted to the First Affiliated Hospital of Hainan Medical College from January 2019 to March 2023 were retrospectively analyzed.The patients were divided into death group(n=47)and survival group(n=112)according to their survival conditions 30 d after infection.The clinical data of the patients were collected,and the strain identification and drug sensitivity test were carried out.The influencing factors of patient death was ana-lyzed using Multiple Logistic regression,and the death prediction model was constructed based on this,and the predictive effect of the prediction model was analyzed by receiver operating characteristic(ROC)curve.Results A total of 165 strains were isolated from 159 patients,Basically,it was multi-drug-resistant bacteria,and the resistance to piperacillin/Tazobactam and yanampenem reached 100％.The resistance to ciproflox-acin,meropenem,cefepime,tobramycin,piperacillin/tazobactam,levofloxacin and ticacillin/clavulanate were 90.91％,89.09％,80.00％,75.15％,71.52％,64.24％and 56.97％,while the resistance to milocycline and tigacycline was low.12.73％and 9.70％;Univariate and multiple Logistic regression analysis showed that APACHE Ⅱ score,septic shock,infection with other pathogens,procalcitonin,antibacterials ap-plication type＞3 were the influencing factors of death(P＜0.05).The risk prediction model was constructed based on the results of multiple Lo-gistic regression analysis.The model was log P=3.526+APACHE Ⅱ score × 0.398+septic shock ×0.413+infection with other pathogens × 0.407+procalcitonin × 0.529+antibiotic application types＞3 × 0.351.Hosmer-Lemeshow test showed x 2=5.336,P=0.219,ROC curve showed that the area under the curve was 0.826(95％CI:0.716-0.887),the optimal critical value was 0.712,the sensitivity,specificity and accuracy were 86.25％,80.56％and 79.35.Conclusion APACHE Ⅱ score,septic shock,and other pathogens are the factors affecting death caused by bloodstream infection of carbpenicillin-resistant Acinetobacter baumannii in hospitals,so it is valuable to build a risk prediction model.
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