急诊重症监护室血流感染患者临床结局的风险因子探讨
Investigation on risk factors for clinical outcomes of patients with bloodstream infections in the emergency intensive care unit
张培 1邰萍 1林康 1李薇 1金铃 1何帮顺 1蔺昕1
作者信息
- 1. 南京医科大学附属南京医院/南京市第一医院医学检验科,南京 210006
- 折叠
摘要
目的 探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据.方法 回顾性收集 2019 年 1 月至 2023 年 4 月我院就诊的 141 例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分析患者死亡的危险因素,运用Cox回归分析上述因素与患者生存时间和临床结局的关系.结果 在 141 例EICU血流感染患者中,两种及以上细菌混合血流感染[比值比(OR)=5.68,95%置信区间(CI):1.20～26.98,P＜0.05]及多重耐药菌血流感染(OR=6.39,95%CI:2.78～14.67,P＜0.01)与患者死亡具有显著相关性;是否根据药敏结果及时调整用药[风险比(HR)=0.47,95%CI:0.30～0.74]和多重耐药菌血流感染(HR=2.02,95%CI:1.28～3.20)是EICU血流感染患者死亡的风险因子(P＜0.01).结论 尽早采集血培养,明确感染病原菌,精准用药控制感染,可以有效降低患者的死亡率.
Abstract
Objective To investigate the risk factors for the clinical outcomes of patients with bloodstream infections in emergency in-tensive care unit(EICU)and provide a basis for clinical treatment.Methods The medical records and blood culture records of 141 patients with bloodstream infections in the EICU of our hospital from January 2019 to April 2023 were retrospectively collected.The risk factors leading to patients′death were analyzed by the Logistic regression and the relationships between these factors and patients′sur-vival time and outcomes were evaluated by the Cox regression.Results Among the 141 patients with bloodstream infections in the EICU,the mixed bloodstream infections of two or more bacteria(odds ratio[OR]=5.68,95%confidence interval[CI]:1.20-26.98,P＜0.05)and bloodstream infections of multidrug-resistant bacteria(OR=6.39,95%CI:2.78-14.67,P＜0.01)were significantly cor-related with the patients′death.Whether to adjust medication in a timely manner based on drug sensitivity results(hazard ratio[HR]=0.47,95%CI:0.30-0.74)and bloodstream infections of multidrug-resistant bacteria(HR=2.02,95%CI:1.28-3.20)were the risk factors leading to the death of patients with bloodstream infections in the EICU(P＜0.01).Conclusion Early blood culture to identify the pathogenic bacteria and precise medication to control infection can effectively reduce the mortality of patients with bloodstream in-fections in the EICU.
关键词
急诊重症监护室/血流感染/血培养/多重耐药菌/精准用药Key words
emergency intensive care unit/bloodstream infection/blood culture/multiple drug resistant bacteria/precision medica-tion引用本文复制引用
基金项目
江苏省医学重点学科建设单位项目(JSDW202239)
出版年
2024
NETL
NSTL
万方数据