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中国上海一家三级医院重症监护病房患者血流感染的危险因素。

Risk factors for bloodstream infection among patients admitted to an intensive care unit of a tertiary hospital of Shanghai, China.

机构信息

Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China.

出版信息

Sci Rep. 2024 Jun 4;14(1):12765. doi: 10.1038/s41598-024-63594-8.

Abstract

Blood flow infections (BSIs) is common occurrences in intensive care units (ICUs) and are associated with poor prognosis. The study aims to identify risk factors and assess mortality among BSI patients admitted to the ICU at Shanghai Ruijin hospital north from January 2022 to June 2023. Additionally, it seeks to present the latest microbiological isolates and their antimicrobial susceptibility. Independent risk factors for BSI and mortality were determined using the multivariable logistic regression model. The study found that the latest incidence rate of BSI was 10.11%, the mortality rate was 35.21% and the mean age of patients with BSI was 74 years old. Klebsiella pneumoniae was the predominant bacterial isolate. Logistic multiple regression revealed that tracheotomy, tigecycline, gastrointestinal bleeding, shock, length of hospital stay, age and laboratory indicators (such as procalcitonine and hemoglobin) were independent risk factors for BSI. Given the elevated risk associated with use of tracheotomy and tigecycline, it underscores the importance of the importance of cautious application of tracheostomy and empirical antibiotic management strategies. Meanwhile, the independent risk factors of mortality included cardiovascular disease, length of hospital stay, mean platelet volume (MPV), uric acid levels and ventilator. BSI patients exhibited a significant decrease in platelet count, and MPV emerged as an independent factor of mortality among them. Therefore, continuous monitoring of platelet-related parameters may aid in promptly identifying high-risk patients and assessing prognosis. Moreover, monitoring changes in uric acid levels may serve as an additional tool for prognostic evaluation in BSI patients.

摘要

血流感染(BSI)在重症监护病房(ICU)中很常见,与预后不良有关。本研究旨在确定 2022 年 1 月至 2023 年 6 月期间上海瑞金医院北院 ICU 收治的 BSI 患者的危险因素,并评估其死亡率。此外,还介绍了最新的微生物分离株及其抗菌药物敏感性。使用多变量逻辑回归模型确定 BSI 和死亡率的独立危险因素。研究发现,BSI 的最新发病率为 10.11%,死亡率为 35.21%,BSI 患者的平均年龄为 74 岁。肺炎克雷伯菌是主要的细菌分离株。逻辑多元回归显示,气管切开、替加环素、胃肠道出血、休克、住院时间、年龄和实验室指标(如降钙素原和血红蛋白)是 BSI 的独立危险因素。鉴于气管切开和替加环素使用相关的风险增加,这突显了气管切开术和经验性抗生素管理策略谨慎应用的重要性。同时,死亡率的独立危险因素包括心血管疾病、住院时间、血小板平均体积(MPV)、尿酸水平和呼吸机。BSI 患者的血小板计数显著下降,MPV 是其中死亡率的独立因素。因此,持续监测血小板相关参数可能有助于及时识别高危患者并评估预后。此外,监测尿酸水平的变化可能是 BSI 患者预后评估的另一个工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d2f9/11150565/1026109f8931/41598_2024_63594_Fig1_HTML.jpg

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