CAJ | 학술논문

目的探讨综合监护病房医院获得性肠杆菌科细菌血流感染(BSI)的危险因素.方法回顾性分析南京医科大学第二附属医院重症医学科综合监护病房2007年1月至2012年12月间南京医科大学第二附属医院重症医学科获得性肠杆菌科及非肠杆菌科细菌BSI患者的临床资料,分析肠杆菌科细菌BSI发生的危险因素,并以是否存活作为预后判定的终点指标,对肠杆菌科细菌BSI分别进行单因素及多因素Logistic回归分析,探究影响其存活的相关因素.结果在96例医院获得性血流感染患者中35例为肠杆菌科细菌BSI,35例肠杆菌科细菌BSI患者中15例死亡,病死率42.9%;就肠杆菌科与非肠杆菌科细菌BSI患者的基础及临床特征对比后发现,影响肠杆菌科细菌BSI发生的危险因素包括急性胰腺炎、接受腹部手术及使用制酸剂(17.1%比4.9%,31.4%比16.4%,77.1%比45.9%;P<0.05 或0.01).对肠杆菌科细菌BSI患者生存组和死亡组各项特征的单因素分析及多因素Logistic回归分析发现,对肠杆菌科细菌BSI患者存活的影响因素包括患者年龄、APACHEⅡ评分、气管插管或切开及ESBL阳性(P<0.05).结论在入住综合监护病房的患者中,急性胰腺炎、接受腹部手术及使用制酸剂的患者更易罹患肠杆菌科细菌BSI;而一旦发生细菌BSI,患者的年龄、APACHEⅡ评分、气管插管或切开及ESBLs阳性是影响其预后的重要因素.
목적 탐토종합감호병방의원획득성장간균과세균혈류감염(BSI)적위험인소.방법회고성분석남경의과대학제이부속의원중증의학과종합감호병방2007년1월지2012년12월간남경의과대학제이부속의원중증의학과획득성장간균과급비장간균과세균BSI환자적림상자료,분석장간균과세균BSI발생적위험인소,병이시부존활작위예후판정적종점지표,대장간균과세균BSI분별진행단인소급다인소Logistic회귀분석,탐구영향기존활적상관인소.결과 재96례의원획득성혈류감염환자중35례위장간균과세균BSI,35례장간균과세균BSI환자중15례사망,병사솔42.9%;취장간균과여비장간균과세균BSI환자적기출급림상특정대비후발현,영향장간균과세균BSI발생적위험인소포괄급성이선염、접수복부수술급사용제산제(17.1%비4.9%,31.4%비16.4%,77.1%비45.9%;P<0.05 혹0.01).대장간균과세균BSI환자생존조화사망조각항특정적단인소분석급다인소Logistic회귀분석발현,대장간균과세균BSI환자존활적영향인소포괄환자년령、APACHEⅡ평분、기관삽관혹절개급ESBL양성(P<0.05).결론 재입주종합감호병방적환자중,급성이선염、접수복부수술급사용제산제적환자경역리환장간균과세균BSI;이일단발생세균BSI,환자적년령、APACHEⅡ평분、기관삽관혹절개급ESBLs양성시영향기예후적중요인소.
Objective To explore the risk factors and its related prognostic factors of hospital-acquired bloodstream infections caused by enterobacteriaceae in general intensive care unit(GICU). Methods The clinical data of hospital-acquired bloodstream infections caused by enterobacteriaceae in general intensive care unit from January 2007 to December 2012 were retrospectively analyzed to determine the risk factors and explore the related prognostic factors of bloodstream infections by mono-factor and Logistic regression analysis. Results There were 35 cases BSI caused by enterobacteriaceae in all 96 patients with hospital-acquired bloodstream infections and the mortality was 42.9%(n=15). The relevant risk factors included acute pancreatitis, abdominal surgery and use of antacids(P<0.05 or 0.01) after a comparison of baseline conditions and clinical characteristics of patients between BSI caused by enterobacteriaceae and non-enterobacteriaceae. And the single factor and multi-factor Logistic regression analysis showed that their prognostic factors included patient age, acute physiology and chronic health evaluation(APACHE) Ⅱ score, tracheal intubation or incision and extended-spectrum beta-lactamase(ESBL) positive(P<0.05). Conclusion The patients admitted into general intensive care unit with acute pancreatitis, abdominal surgery and use of antacids are more likely to suffer from EBSI. And patient age, APACHE Ⅱ score, tracheal intubation or incision and ESBL are important prognostic factors.