鲍曼不动杆菌无菌体液感染患者归因危险度多中心回顾性队列研究

A multicenter retrospective cohort study on the attributable risk of patients with Acinetobacter baumannii sterile body fluid infection

摘要:

目的 调查重症患者感染鲍曼不动杆菌(AB)后的归因危险度(AR)。 方法 围绕成人重症监护病房(ICU)患者开展多中心回顾性队列研究。以各中心从无菌体液中分离出AB且确认AB感染患者为感染组, 以同期、同一ICU、相似的急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)评分(±5分)和入住ICU的主要诊断为匹配条件, 按1 ∶2比例选取未感染AB患者作为非感染组, 计算AR。 结果 AB无菌体液感染患者住院病死率为33.3%, 非感染组患者为23.1%, 两组数据比较, 差异无统计学意义(P=0.069), AR为10.2%(95%CI: -2.3%~22.8%)。血、脑脊液等标本来源的感染组和非感染组患者病死率比较, 差异无统计学意义(P＞0.05)。主要诊断为肺部感染的重症患者感染AB后AR最高, 但感染组和非感染组患者病死率比较, 差异无统计学意义(P＞0.05), 其他诊断分类同样如此。 结论 重症患者AB感染预后被严重高估, 但ICU仍应针对AB进行积极医院感染控制。

Abstract:

Objective To investigate the attributable risk (AR) of Acinetobacter baumannii (AB) infection in criti- cally ill patients. Methods A multicenter retrospective cohort study was conducted among adult patients in intensive care unit (ICU). Patients with AB isolated from sterile body fluid and confirmed with AB infection in each center were selected as the infected group. According to the matching criteria that patients should be from the same period, in the same ICU, as well as with similar APACHE Ⅱ score (±5 points) and primary diagnosis, patients who did not infect with AB were selected as the non-infected group in a 1:2 ratio. The AR was calculated. Results The in-hospital mortality of patients with AB infection in sterile body fluid was 33.3%, and that of non-infected group was 23.1%, with no statistically significant difference between the two groups (P=0.069). The AR was 10.2% (95%CI: -2.3%-22.8%). There is no statistically significant difference in mortality between non-infected patients and infected patients from whose blood, cerebrospinal fluid and other specimen sources AB were isolated (P>0.05). After infected with AB, critically ill patients with the major diagnosis of pulmonary infection had the highest AR. There was no statistically significant difference in mortality between patients in the infected and non-infected groups (P>0.05), or between other diagnostic classifications. Conclusion The prognosis of AB infection in critically ill patients is highly overestimated, but active healthcare-associated infection control for AB in the ICU should still be carried out.