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重症监护病房多重耐药患者的差异特征:既往抗生素治疗对临床特征的影响。

Differential Profiles of intensive care unit multidrug-resistant patients: Influence of prior antibiotic therapy on clinical features.

作者信息

Arshad Ramsha Ghazal, Toori Kaleem Ullah, Rahim Javeria

机构信息

Ramsha Ghazal Arshad, MBBS KRL Hospital, Islamabad, Pakistan.

Kaleem Ullah Toori, MBBS, MRCP, FRCP KRL Hospital, Islamabad, Pakistan.

出版信息

Pak J Med Sci. 2025 Mar;41(3):706-711. doi: 10.12669/pjms.41.3.10392.

Abstract

OBJECTIVES

To study the characteristics and their influence on outcomes of ICU patients with multi drug resistant infections with and without prior antibiotic use before admission.

METHODS

This single center study included 365 patients admitted to Medical and Surgical ICUs of KRL Hospital, Islamabad, from January 2023 to January 2024, who acquired a multi drug resistant infection 48 hours post-admission to the ICU. This was an observational study and purposive sampling was done. Kolmogorov-Smirnov test was employed to test the normality of data. The chi-square test was used to observe the association between categorical variables. The Mann-Whitney U test was used for continuous variables. Multivariate analysis was employed to compare the effect of different parameters on mortality.

RESULTS

A total of 365 patients were included. The mean age was 62.2 ± 17.1, (<65 years = 54.2% and >65 years = 45.8%) with 185 (50.7%) males. Males, diabetics, those with chronic kidney disease, DCLD, CVA, hospitalization in last 6 months had a greater frequency of prior antibiotic exposure. Similarly, this group also showed increased frequency of thrombocytopenia and prolonged ICU stay than those with no previous antibiotic exposure. Longer duration of indwelling lines, hospital stay, ICU stay and Mechanical ventilation was associated with increased mortality.

CONCLUSION

Previous antibiotic use is linked to longer ICU and hospital stays, extended use of indwelling lines, and increased duration of mechanical ventilation, all of which contribute to greater financial burdens. However, there was no significant difference in mortality between the antibiotic and non-antibiotic groups. Further studies conducted on a larger scale across multiple ICUs could provide deeper insights into this relationship.

摘要

目的

研究入住重症监护病房(ICU)时伴有或不伴有入院前抗生素使用史的多重耐药感染患者的特征及其对预后的影响。

方法

这项单中心研究纳入了2023年1月至2024年1月期间入住伊斯兰堡KRL医院内科和外科ICU的365例患者,这些患者在入住ICU 48小时后发生了多重耐药感染。这是一项观察性研究,采用了目的抽样法。使用柯尔莫哥洛夫-斯米尔诺夫检验来检验数据的正态性。使用卡方检验来观察分类变量之间的关联。使用曼-惠特尼U检验来分析连续变量。采用多变量分析来比较不同参数对死亡率的影响。

结果

共纳入365例患者。平均年龄为62.2±17.1岁(<65岁=54.2%,>65岁=45.8%),男性185例(50.7%)。男性、糖尿病患者、患有慢性肾脏病、弥漫性间质性肺疾病、脑血管意外(CVA)以及过去6个月内有住院史的患者,入院前抗生素暴露的频率更高。同样,与无入院前抗生素暴露的患者相比,该组血小板减少症的发生率更高,ICU住院时间更长。留置导管时间、住院时间、ICU住院时间和机械通气时间延长与死亡率增加相关。

结论

既往使用抗生素与更长的ICU和住院时间、留置导管的长期使用以及机械通气时间延长有关,所有这些都会导致更大的经济负担。然而,抗生素组和非抗生素组之间的死亡率没有显著差异。在多个ICU进行的更大规模的进一步研究可以更深入地了解这种关系。

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