体外心肺复苏术治疗住院心脏骤停患者的医院感染。
Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation.
机构信息
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
PLoS One. 2020 Dec 23;15(12):e0243838. doi: 10.1371/journal.pone.0243838. eCollection 2020.
BACKGROUND
Little is known of nosocomial infections (NI) in patients who suffer from in-hospital cardiac arrest who undergoing extracorporeal cardiopulmonary resuscitation. This study aimed to investigate clinical pictures of NI, and the association of NIs with clinical outcomes in in-hospital cardiac arrest patients who undergoing extracorporeal cardiopulmonary resuscitation.
METHODS
To evaluate the incidence and clinical characteristics of NI in patients who undergoing extracorporeal cardiopulmonary resuscitation, a retrospective cohort study was conducted in a single tertiary referral center between January 2010 and December 2018. We included adult patients who undergoing extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest and excluded patients who were out-of-hospital cardiac arrest or failed ECMO implantation. Clinical characteristics and outcomes were compared between NI and Non-NI patients, or multidrug-resistant (MDR) and non-MDR. The independent risk factors associated with NIs were also analyzed using multivariable logistic regression model.
RESULTS
Thirty-five (23.3%) patients developed a NI. These cases included 21 patients with a gram negative (G-) infection, 12 patients with a gram positive (G+) bacterial infection, and two patients with fungal infection. Pneumonia was the most common type of NIs, followed by catheter-related infection. The in-hospital mortality and neurologic outcomes at discharge were not different between the NI and non-NI groups. Multidrug-resistant (MDR) pathogens were detected in 10 cases (28.6%). The MDR NI patients had a higher ICU mortality than did those with non-MDR NI (80% vs. 32%, p = 0.028). Following multivariable adjustment, body mass index (adjusted OR 0.87, 95% CI, 0.77-0.97, p = 0.016) and cardiopulmonary resuscitation to pump on time (adjusted OR 1.04, 95% CI, 1.01-1.06, p = 0.001) were independent predictors of NI development.
CONCLUSIONS
In patients who received extracorporeal cardiopulmonary resuscitation, NIs were not associated with an increase in in-hospital mortality. However, NIs with MDR organisms do increase the risk of in-hospital mortality. Lower body mass index and longer low flow time were significant predictors of NI development.
背景
在接受体外心肺复苏的院内心脏骤停患者中，关于医院获得性感染（NI）的信息知之甚少。本研究旨在探讨接受体外心肺复苏的院内心脏骤停患者 NI 的临床特征，并分析 NI 与临床结局的关系。
方法
为了评估接受体外心肺复苏的患者中 NI 的发生率和临床特征，我们对 2010 年 1 月至 2018 年 12 月在一家三级转诊中心进行的回顾性队列研究进行了评估。我们纳入了接受体外心肺复苏治疗的院内心脏骤停患者，排除了院外心脏骤停或 ECMO 植入失败的患者。比较 NI 与非 NI 患者，或多重耐药（MDR）与非 MDR 患者的临床特征和结局。使用多变量逻辑回归模型分析与 NI 相关的独立危险因素。
结果
35 例（23.3%）患者发生 NI。这些病例包括 21 例革兰氏阴性（G-）感染、12 例革兰氏阳性（G+）细菌感染和 2 例真菌感染。肺炎是最常见的 NI 类型，其次是导管相关感染。NI 组与非 NI 组的院内死亡率和出院时的神经功能结局无差异。10 例（28.6%）检测到 MDR 病原体。与非 MDR NI 患者相比，MDR NI 患者 ICU 死亡率更高（80% vs. 32%，p = 0.028）。多变量调整后，体重指数（调整后的 OR 0.87，95%CI，0.77-0.97，p = 0.016）和心肺复苏及时开始泵（调整后的 OR 1.04，95%CI，1.01-1.06，p = 0.001）是 NI 发生的独立预测因素。
结论
在接受体外心肺复苏的患者中，NI 与院内死亡率增加无关。然而，MDR 病原体引起的 NI 确实增加了院内死亡率。较低的体重指数和较长的低血流时间是 NI 发生的显著预测因素。
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