Risk factors of pneumonia caused by Gram-negative bacteria secondary to craniocerebral injury and selection of empirical antimicrobial agents:A retrospective case-case-control study
Objective To analyze the risk factors of pneumonia caused by non-multidrug-resistant Gram-negative bacteria(Non-MDRGNB)and multidrug-resistant Gram-negative bacteria(MDRGNB)in patients with craniocerebral injury and to investigate the strain composition and drug resistance of Gram-negative bacteria(GNB),so as to provide reference for appropriate empirical antibacterial therapy.Methods Clinical data of patients with craniocerebral injuries admitted to our hospital from May 2020 to July 2022 were retrospectively analyzed.According to the positive GNB in the respiratory tract,patients with secondary GNB-induced pneumonia were included in the case group,and patients without clinical infection indications of pulmonary or pneumonia caused by non-GNB were included in the control group.For patients with secondary GNB pneumonia,the case group was further divided into two subgroups according to pathogen resistance,namely the MDRGNB infection group and the non-MDRGNB infection group,forming a case-case-control grouping mode.The differences in clinical data between the case group and the control group were compared,and the variables with significant differences were included in multivariate unconditioned logistic regression analysis to screen the independent risk factors of MDRGNB infection and non-MDRGNB infection,respectively.Subsequently,the pathogen composition and drug resistance of the two case groups were investigated,respectively.Results A total of 188 patients were included,including 113 cases in the control group,48 cases in the MDRGNB infection group,and 27 cases in the non-MDRGNB infection group.Multivariate logistic regression analysis showed that mild hypothermia(OR=6.380,95％CI=1.838～22.146,P=0.004)was an independent risk factor for non-MDRGNB infection.Mild hypothermia(OR=5.419,95％CI=2.030～14.465,P=0.001),mechanical ventilation duration(OR=1.095,95％CI=1.003～41.196,P=0.043)and use of carbapenem antibacterial drug(OR=2.900,95％CI=1.137～7.397,P=0.026)were independent risk factors for MDRGNB infection.A total of 31 strains of pathogenic bacteria were detected in the non-MDRGNB group,mainly Klebsiella pneumoniae(45.16％).A total of 55 strains of pathogenic bacteria were detected in the MDRGNB group,mainly Acinetobacter baumannii(32.73％).The results of the drug sensitivity test showed that the sensitivity rate of non-MDRGNB group to ampicillin sulbactam and ticacillinclavic acid was less than 80.00％,the sensitivity rate to other antibacterial drugs was more than 80.00％.While the MDRGNB group had the highest sensitivity rate to minocycline(84.50％)and polymyxin B(100.00％).The sensitivity rates to other antibiotics were all less than 30.00％.Conclusion Mild hypothermia was significantly associated with both non-MDRGNB and MDRGNB infections,while mechanical ventilation duration and the use of carbapenems were only significantly associated with MDRGNB infections.The non-MDRGNB infection group was more sensitive to most antibiotics.Minocycline,tegacycline or polymyxin-based combination antimicrobial therapy should be considered in patients at high risk of MDRGNB infection.
NETL
NSTL
万方数据
