目的 本研究旨在探讨急性肾损伤(AKI)患者中医院获得性感染(HAIs)的病原菌分布特点,并分析其相关危险因素.方法 本研究纳入2021年1月至2023年12月期间我院收治的300例AKI住院患者.收集患者的基本信息、临床资料及实验室检测数据,并记录患者在住院期间发生的HAIs情况.通过微生物培养及药敏试验,确定病原菌种类及其耐药性谱.使用单因素分析和多因素Logistic回归分析,评估影响AKI患者医院获得性感染的独立危险因素.结果 在300例AKI患者中,HAIs的发生率为32.66％(98例),共分离出114株病原菌.革兰阴性菌占58.77％(67株),主要包括肺炎克雷伯菌(28.07％)和大肠埃希菌(21.93％).革兰阳性菌占35.96％(41株),其中MRSA占16.66％.真菌感染占5.33％(6株),以白色念珠菌(3.51％)为主.耐药性分析显示,肺炎克雷伯菌对头孢曲松的耐药率为48.44％,对碳青霉烯类的耐药率为12.87％.大肠埃希菌对头孢曲松的耐药率为44.00％.MRSA对万古霉素保持100％敏感,但对利福平的耐药率为21.05％.真菌中,白色念珠菌对氟康唑的耐药率为25.00％.多因素Logistic回归分析表明,插管时间延长(OR=1.70,95％CI:1.45-1.99,P＜0.01)、使用广谱抗生素(OR=6.07,95％CI:2.86-12.88,P＜0.01)、高龄(OR=1.07,95％CI:1.01-1.12,P=0.012)是 AKI 患者 HAIs 的独立危险因素.结论 本研究发现,在AKI患者中,医院获得性感染的病原菌主要为革兰阴性菌,且具有较高的耐药性.延长插管时间、广谱抗生素使用和高龄是HAIs的重要危险因素.这些结果表明,应加强对高危AKI患者的感染监测,合理使用抗菌药物,以降低HAIs的发生率和相关不良结局,优化临床管理策略.
Analysis of pathogen distribution characteristics and risk factors of hospital-acquired infections in patients with acute kidney injury
Objective This study aimed to investigate the distribution characteristics of pathogens in hospital-acquired infections(HAIs)among patients with acute kidney injury(AKI)and to analyze the associated risk factors.Methods A total of 300 AKI inpatients admitted to our hospital from January 2021 to December 2023 were included in the study.Patients'basic demographic information,clinical data,and laboratory results were collected,and the occurrence of HAIs during hospitalization was recorded.Microbiological cultures and antimicrobial susceptibility testing were conducted to identify the types of pathogens and their resistance profiles.Univariate analysis and multivariate logistic regression were used to assess the independent risk factors for HAIs in AKI patients.Results Among 300 patients with AKI,the incidence of HAIs was 32.66％(98 cases),with a total of 114 pathogenic isolates identified.Gram-negative bacteria accounted for 58.77％(67 isolates),with Klebsiella pneumoniae(28.07％)and Escherichia coli(21.93％)being the most common.Gram-positive bacteria comprised 35.96％(41 isolates),with methicillin-resistant Staphylococcus aureus(MRSA)representing 16.66％.Fungal infections accounted for 5.33％(6 isolates),predominantly caused by Candida albicans(3.51％).Antimicrobial resistance analysis revealed that the resistance rate of Klebsiella pneumoniae to ceftriaxone was 48.44％,and its resistance to carbapenems was 12.87％.The resistance rate of Escherichia coli to ceftriaxone was 44.00％.MRSA remained 100％sensitive to vancomycin,but its resistance to rifampin was 21.05％.Among the fungi,Candida albicans exhibited a resistance rate of 25.00％to fluconazole.Multivariate logistic regression analysis indicated that prolonged intubation duration(OR=1.70,95％CI:1.45-1.99,P＜0.01),use of broad-spectrum antibiotics(OR=6.07,95％CI:2.86-12.88,P＜0.01),and advanced age(OR=1.07,95％CI:1.01-1.12,P=0.012)were independent risk factors for HAIs in AKI patients.Conclusion The study found that Gram-negative bacteria,particularly K.pneumoniae and E.coli,are the predominant pathogens in HAIs among AKI patients and exhibit high levels of antimicrobial resistance.Prolonged intubation,use of broad-spectrum antibiotics,and advanced age are significant risk factors for HAIs.These findings highlight the need for enhanced infection monitoring,judicious use of antibiotics,and optimized clinical management strategies to reduce the incidence of HAIs and associated adverse outcomes in high-risk AKI patients.
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