新型“RISC”评分作为成人脓毒症患者耐碳青霉烯类医院获得性感染的风险预测模型——一项前瞻性观察研究。
The Novel "RISC" Score as a Risk-prediction Model of Carbapenem-resistant Hospital-acquired Infections in Adult Sepsis Patients - A Prospective Observational Study.
作者信息
Mareguddi Abhilash B, Chaudhuri Souvik, Shanmukhappa Sagar M, Parampalli Vishwas, Bhatt Margiben T, Fernandes Roshan, Rao Shwethapriya, Birajdar Poornima S
机构信息
Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Anesthesiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
出版信息
Indian J Crit Care Med. 2025 Apr;29(4):352-362. doi: 10.5005/jp-journals-10071-24953.
AIM AND BACKGROUND
Antimicrobial sensitivity (AMS) reports are often available after 72 hours of identification of gram-negative (GN) hospital-acquired infection (HAI). Prediction of carbapenem-resistant infection (CRI) among GN strains is important even before AMS reports are available, for judicious use of empirical antibiotics. We aimed to study the predictors of CRI in patients with HAI.
MATERIALS AND METHODS
We conducted a single-center prospective observational study between April 2023 and September 2024 on patients of GN sepsis with HAI. The use of empirical carbapenem antibiotics, organ dysfunction scores, the modified nutritional risk in critically ill (mNUTRIC) score, blood-count-derived inflammation indices, type of HAI, AMS reports, and in-hospital mortality were noted.
RESULTS
A total of 935 sepsis patients with HAI were screened, and there were 195 patients with GN infection. Among the 195 patients, 145 (74.4%) had CRI and 50 (25.6%) had non-CRI. Multivariable logistic regression revealed that the length of intensive care unit (ICU) stay before the day of HAI ( = 0.009, adjusted odds ratio (OR) 1.155, 95% confidence interval (CI) 1.037-1.286), presence of ventilator-associated pneumonia (VAP) (-value < 0.001, adjusted OR 4.170, 95% CI: 1.858-9.361), empirical carbapenem antibiotics before the day of HAI (-value = 0.004, adjusted OR 3.164, 95% CI: 1.439-6.957), and septic shock on the day of HAI (-value 0.012, adjusted OR 4.162, 95% CI: 1.366-12.677) were the independent risk factors of CRI.
CONCLUSION
In GN sepsis patients with HAI, respiratory infection (VAP), length of ICU stay prior to HAI, septic shock, and empirical carbapenem antibiotic administration are risk factors of CRI.
HOW TO CITE THIS ARTICLE
Mareguddi AB, Chaudhuri S, Shanmukhappa SM, Parampalli V, Bhatt MT, Fernandes R, . The Novel "RISC" Score as a Risk-prediction Model of Carbapenem-resistant Hospital-acquired Infections in Adult Sepsis Patients - A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):352-362.
目的与背景
革兰阴性菌（GN）医院获得性感染（HAI）确诊72小时后通常可获得抗菌药物敏感性（AMS）报告。在AMS报告出来之前，预测GN菌株中的碳青霉烯耐药感染（CRI）对于合理使用经验性抗生素很重要。我们旨在研究HAI患者中CRI的预测因素。
材料与方法
我们于2023年4月至2024年9月对患有GN败血症的HAI患者进行了一项单中心前瞻性观察研究。记录了经验性碳青霉烯类抗生素的使用情况、器官功能障碍评分、危重症患者改良营养风险（mNUTRIC）评分、血常规衍生的炎症指标、HAI类型、AMS报告以及院内死亡率。
结果
共筛查了935例患有HAI的败血症患者，其中195例为GN感染。在这195例患者中，145例（74.4%）发生了CRI，50例（25.6%）为非CRI。多变量逻辑回归显示，HAI当天前的重症监护病房（ICU）住院时间（ = 0.009，调整优势比（OR）1.155，95%置信区间（CI）1.037 - 1.286）、呼吸机相关性肺炎（VAP）的存在（-值<0.001，调整OR 4.170，95% CI：1.858 - 9.361）、HAI当天前使用经验性碳青霉烯类抗生素（-值 = 0.004，调整OR 3.164，95% CI：1.439 - 6.957）以及HAI当天的感染性休克（-值0.012，调整OR 4.162，95% CI：1.366 - 12.677）是CRI的独立危险因素。
结论
在患有HAI的GN败血症患者中，呼吸道感染（VAP）、HAI前的ICU住院时间、感染性休克以及经验性碳青霉烯类抗生素的使用是CRI的危险因素。
如何引用本文
Mareguddi AB, Chaudhuri S, Shanmukhappa SM, Parampalli V, Bhatt MT, Fernandes R,. 新型“RISC”评分作为成人败血症患者碳青霉烯耐药医院获得性感染的风险预测模型——一项前瞻性观察研究。《印度重症监护医学杂志》2025；29(4)：352 - 362。
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