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重症监护病房感染的微生物多重耐药菌(MDRO)图谱

Microbial Multidrug-Resistant Organism (MDRO) Mapping of Intensive Care Unit Infections.

作者信息

Yassin Ahmed, Eid Ragaey Ahmad, Mohammad Mohammad Farouk, Elgendy Marwa O, Mohammed Zeinab, Abdelrahim Mohamed E A, Abdel Hamied Ahmed M, Binsuwaidan Reem, Saleh Asmaa, Hussein Mona, Mohamed Eman Hamdy

机构信息

Department of Critical Care Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef 62514, Egypt.

Department of Gastroenterology, Hepatology and Infectious Diseases, (Tropical Medicine Department), Faculty of Medicine, Beni-Suef University, Beni-Suef 62514, Egypt.

出版信息

Medicina (Kaunas). 2025 Jul 4;61(7):1220. doi: 10.3390/medicina61071220.

Abstract

This study aims to identify risk factors associated with MDRO infections and assess their impact on patient outcomes in Egyptian ICUs. : The widespread overuse of antimicrobials has led to antibiotic multidrug resistance, posing significant challenges in intensive care units (ICUs) and leading to increased morbidity, mortality, and healthcare costs. A prospective observational study was conducted over 12 months, including 113 adult patients admitted to the ICU with confirmed bacterial infections. Comprehensive medical assessments and routine investigations were performed, including multisource cultures based on clinical suspicion. Patient histories, underlying conditions, and disease progression were documented. Patients were classified into two groups: those infected with MDROs and those without MDRO infections. : Significant differences were observed between patients with and without MDRO infections regarding temperature, pH, PaO, HCO, serum creatinine levels, high-dose inotropes, and inotrope dependence (-values: 0.01, 0.028, 0.036, 0.008, <0.001, 0.013, 0.029, 0.039, <0.001, and 0.003, respectively). Additionally, cerebrovascular stroke and renal failure were significantly more frequent in MDRO-infected patients (-values: 0.048 and 0.007, respectively). MDROs accounted for 42% of infections. The most commonly detected MDRO was spp. (52%). Patients with MDRO infections showed significantly higher mortality (42.6%), increased incidence of ARDS, invasive ventilation, and longer ventilation durations. Independent risk factors included prior antibiotic use (OR: 3.2; 95% CI: 1.5-6.8) and invasive device presence (OR: 2.7; 95% CI: 1.2-5.9). : Cerebrovascular stroke and renal failure appear to be risk factors for MDRO infections. MDRO infections in ICUs are associated with poor clinical outcomes and increased complications. Improved antimicrobial stewardship and targeted prevention strategies are urgently required.

摘要

本研究旨在确定与多重耐药菌(MDRO)感染相关的危险因素,并评估其对埃及重症监护病房(ICU)患者预后的影响。抗菌药物的广泛过度使用导致了抗生素多药耐药性,在重症监护病房(ICU)带来了重大挑战,并导致发病率、死亡率和医疗成本增加。进行了一项为期12个月的前瞻性观察性研究,纳入了113名入住ICU且确诊为细菌感染的成年患者。进行了全面的医学评估和常规检查,包括基于临床怀疑的多源培养。记录了患者病史、基础疾病和疾病进展情况。患者被分为两组:感染MDRO的患者和未感染MDRO的患者。在感染MDRO和未感染MDRO的患者之间,观察到体温、pH值、动脉血氧分压(PaO)、碳酸氢根(HCO)、血清肌酐水平、高剂量血管活性药物使用情况以及血管活性药物依赖方面存在显著差异(P值分别为:0.01、0.028、0.036、0.008、<0.001、0.013、0.029、0.039、<0.001和0.003)。此外,脑血管意外和肾衰竭在MDRO感染患者中显著更常见(P值分别为:0.048和0.007)。MDRO占感染的42%。最常检测到的MDRO是[具体菌种](52%)。感染MDRO的患者死亡率显著更高(42.6%),急性呼吸窘迫综合征(ARDS)、有创通气的发生率增加,且通气持续时间更长。独立危险因素包括既往使用抗生素(比值比:3.2;95%置信区间:1.5 - 6.8)和存在侵入性装置(比值比:2.7;95%置信区间:1.2 - 5.9)。脑血管意外和肾衰竭似乎是MDRO感染的危险因素。ICU中的MDRO感染与不良临床结局和并发症增加相关。迫切需要改善抗菌药物管理和针对性的预防策略。

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