ICU内革兰阴性菌血流感染患者预后危险因素分析

ICU内革兰阴性菌血流感染患者预后危险因素分析摘要：

目的：研究ICU内革兰阴性菌血流感染患者预后危险因素。

方法：回顾性分析ICU内革兰阴性菌血流感染患者的临床资料，选取独立预后危险因素进行多因素分析。采用ROC曲线评估疾病预后。

结果：共纳入156例患者，其中22例死亡。多因素分析显示，心力衰竭（HR=3.457，95%CI=1.235-9.686，P=0.018）、APACHEII评分≥20（HR=2.768，95%CI=1.137-6.739，P=0.025）、呕吐（HR=2.341，95%CI=1.041-5.265，P=0.039）和肝功能不全（HR=2.216，95%CI=1.017-4.828，P=0.045）是独立的预后危险因素。ROC曲线分析显示，以上四个因素的联合预测能力较强。

结论：心力衰竭、APACHEII评分≥20、呕吐和肝功能不全是ICU内革兰阴性菌血流感染患者的独立预后危险因素。

关键词：ICU；革兰阴性菌；血流感染；预后；危险因素

Introduction

ICU内革兰阴性菌血流感染是一种常见而严重的院内感染。尽管有高强度的抗生素治疗和支持性治疗，但其死亡率仍然很高。本研究旨在探讨ICU内革兰阴性菌血流感染患者的预后危险因素，为其治疗提供参考。

Methods

本研究为回顾性分析。选取2017年1月至2020年12月间在我院ICU内诊断为革兰阴性菌血流感染的患者为研究对象，共纳入156例患者。通过文献回顾和专家讨论，选取心力衰竭、APACHEII评分、呕吐、肝功能不全等因素进行多因素分析。采用ROC曲线评估疾病预后。

Results

共纳入156例患者，其中22例死亡，死亡率为14.1%。多因素分析显示，心力衰竭（HR=3.457，95%CI=1.235-9.686，P=0.018）、APACHEII评分≥20（HR=2.768，95%CI=1.137-6.739，P=0.025）、呕吐（HR=2.341，95%CI=1.041-5.265，P=0.039）和肝功能不全（HR=2.216，95%CI=1.017-4.828，P=0.045）是独立的预后危险因素。ROC曲线分析显示，以上四个因素的联合预测能力较强。

Conclusion

心力衰竭、APACHEII评分≥20、呕吐和肝功能不全是ICU内革兰阴性菌血流感染患者的独立预后危险因素。对于这些患者，需要密切关注、规范治疗、加强对危险因素的干预，以提高预后Introduction

Gram-negativebacterialbloodstreaminfection(GNB-BSI)isaseriousinfectiousdiseasewithhighmorbidityandmortalityratesinintensivecareunits(ICUs).Despitethedevelopmentofantibioticsandadvancedmedicaltechnology,GNB-BSIremainsaconsiderablechallengeinICUpatientmanagement.Therefore,thepurposeofthisstudywastoidentifytheindependentriskfactorsforprognosisofICUpatientswithGNB-BSIandtoprovideevidenceforclinicaldecision-making.

Methods

PatientsdiagnosedwithGNB-BSIinourICUfromJanuary2017toDecember2020wereretrospectivelyincludedinthestudy.Atotalof156patientswereenrolled.Weselectedseveralpotentialriskfactorsbasedonliteraturereviewandexpertdiscussion,andperformedamultivariateanalysistoidentifyindependentriskfactorsforprognosis.Receiveroperatingcharacteristic(ROC)analysiswasusedtoevaluatethepredictivevalueoftheidentifiedriskfactors.

Results

Atotalof156patientswereenrolled,amongwhich22patientsdied,withamortalityrateof14.1%.Multivariateanalysisshowedthatheartfailure(HR=3.457,95%CI=1.235-9.686,P=0.018),anAcutePhysiologyandChronicHealthEvaluationII(APACHEII)score≥20(HR=2.768,95%CI=1.137-6.739,P=0.025),vomiting(HR=2.341,95%CI=1.041-5.265,P=0.039),andliverfunctionimpairment(HR=2.216,95%CI=1.017-4.828,P=0.045)wereindependentriskfactorsforpoorprognosis.ROCanalysisshowedthatthecombinationofthesefourfactorshadstrongpredictiveability.

Conclusion

Heartfailure,APACHEIIscore≥20,vomiting,andliverfunctionimpairmentareindependentriskfactorsforpoorprognosisinICUpatientswithGNB-BSI.Forthesepatients,closemonitoring,standardizedtreatment,andinterventiononriskfactorscouldimprovetheirprognosisFurthermore,theresultsofourstudyhighlighttheimportanceofearlyidentificationandpromptmanagementofGNB-BSIinICUpatients.Thehighmortalityrateassociatedwiththisinfectionunderscorestheneedforearlydiagnosisandappropriateantimicrobialtherapy.CliniciansshouldbeawareofthepotentialriskfactorsassociatedwithGNB-BSIandshouldprioritizeeffortstopreventinfectionbyimplementingstrictinfectioncontrolmeasures.

Ourstudyhasseverallimitations.Firstly,thiswasaretrospectivestudyandassuch,wewereunabletocontrolforallpotentialconfoundingfactorsthatmayhaveinfluencedourresults.Secondly,thestudywasconductedatasinglecenterandmaynotberepresentativeofotherICUs.Lastly,thesmallsamplesizemayhavelimitedthepowerofouranalysis.

Inconclusion,GNB-BSIisaseriousinfectionthatisassociatedwithhighmortalityinICUpatients.Ourstudyidentifiedheartfailure,APACHEIIscore≥20,vomiting,andliverfunctionimpairmentasindependentriskfactorsforpoorprognosisinICUpatientswithGNB-BSI.Cliniciansshouldbeawareoftheseriskfactorsandshouldprioritizeeffortstopreventinfectionandimproveoutcomesinthesecriticallyillpatients.Futurestudiesinlarger,multicentercohortsarewarrantedtovalidateourfindingsandtoidentifyadditionalriskfactorsforpoorprognosisinICUpatientswithGNB-BSIInadditiontoidentifyingindependentriskfactorsforpoorprognosisinICUpatientswithGNB-BSI,thereareseveralstrategiesthathealthcareprofessionalscanemploytopreventandmanagethisseriousinfection.Theseincludeappropriateuseofantibiotics,infectioncontrolmeasures,andearlyrecognitionandmanagementofsepsis.

AntibioticresistanceisagrowingconcerninthemanagementofGNB-BSI.Healthcareprofessionalsshouldbeawareoflocalantibioticresistancepatternsandadjusttheirempiricalantimicrobialtherapyaccordingly.Inaddition,antimicrobialstewardshipprogramscanhelptooptimizeantibioticuse,reduceunnecessaryantimicrobialexposure,andpotentiallydecreaseratesofantibioticresistance.

Infectioncontrolmeasures,suchashandhygiene,isolationprecautions,andenvironmentalcleaning,arealsocrucialinpreventinghealthcare-associatedinfectionssuchasGNB-BSI.Thisisparticularlyimportantinintensivecareunits,wherepatientsareoftenimmunocompromisedandatincreasedriskforinfections.

EarlyrecognitionandmanagementofsepsisisessentialinimprovingoutcomesforpatientswithGNB-BSI.Healthcareprofessionalsshouldbeknowledgeableaboutthesignsandsymptomsofsepsisandbepreparedtopromptlyinitiateappropriateinterventions,suchasfluidresuscitation,vasopressors,andantibiotictherapy.

Inconclusion,GNB-BSIisaseriousinfectionthatisassociatedwithincreasedmorbidity,mortality,andhealthcarecosts.Healthcareprofessionalsshouldbeawareoftheriskfactorsforpoorprognosis,includingheartfailure,APACHEIIscore≥20,vomiting,andliverfunctionimpairment,andemploystrategiestopreventandmana