静脉-静脉体外膜肺氧合患者医院感染特征及危险因素

Characteristics and risk factors of healthcare-associated infection in patients receiving veno-venous extracorporeal membrane oxygenation treatment

摘要:

目的 分析静脉-静脉体外膜肺氧合(V-V ECMO)患者发生医院感染的特征及危险因素。方法 收集青岛市某三级甲等医院2019年1月—2023年11月综合重症监护病房(ICU)收治的141例V-V ECMO患者的临床资料,根据是否发生医院感染分为感染组与非感染组,分析医院感染的特征,并对其危险因素进行单因素和多因素logistic回归分析。结果 141例V-V ECMO患者中,医院感染发病率为37.59%(53例)。感染组患者共培养出病原体81株,其中革兰阴性菌占比56.79%(46株),以鲍曼不动杆菌为主,达28.39%［耐碳青霉烯类鲍曼不动杆菌(CRAB)占16.05%］。V-V ECMO患者医院感染主要类型为单纯肺部感染(54.72%),其次为单纯血流感染(20.75%),多部位感染占22.64%。单因素分析结果显示,与非感染组相比,感染组患者免疫抑制类药物应用史、ICU转入史、手术史、应用纤维支气管镜、接受肾脏替代治疗、ICU住院时长、气管插管和/或气管切开时长、导尿管插管时长、胃管置入时长、中心静脉置管时长、抗菌药物使用时长、V-V ECMO支持时长差异均具有统计学意义(均P<0.05)。多因素logistic回归分析结果表明,ICU转入史、应用纤维支气管镜是V-V ECMO患者医院感染的独立危险因素(OR分别为6.850、4.643,均P<0.05)。结论 医院应针对V-V ECMO患者医院感染特征及相关危险因素采取有效的防控措施,减少医院感染的发生。

Abstract:

Objective To analyze the characteristics and risk factors of healthcare-associated infection (HAI) in patients receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) treatment. Methods Clinical data of 141 patients who received V-V ECMO treatment in the intensive care unit (ICU) of a tertiary first-class hospital in Qingdao from January 2019 to November 2023 were collected. Patients were divided into the infection group and non-infection group based on whether HAI occurred. Characteristics of HAI were analyzed, risk factors were analyzed by univariate and multivariate logistic regression analyses. Results Among 141 V-V ECMO patients, incidence of HAI was 37.59% (n=53). A total of 81 strains of pathogens were isolated from patients in the infection group, Gram-negative bacteria accounted for 56.79% (n=46), mainly Acinetobacter baumannii, which was up to 28.39% (carbapenem-resistant Acinetobacter baumannii ［CRAB］ accounted for 16.05%). The main type of HAI in V-V ECMO patients was pulmonary infection alone (54.72%), followed by bloodstream infection alone (20.75%), multi-site infection accounted for 22.64%. Univariate analysis result showed that compared with the non-infection group, there were statistically significant differences in the history of immunosuppressive agents use, ICU transfer history, surgical history, fiberbronchoscopy, renal replacement therapy, duration of ICU stay, duration of tracheal intubation and/or tracheotomy, duration of urinary catheterization, duration of gastric tube placement, duration of central venous catheterization, duration of antimicrobial use, and duration of V-V ECMO support (all P<0.05). Multivariate logistic regression analysis result showed that ICU transfer history and fiberbronchoscopy were independent risk factors for HAI in V-V ECMO patients (OR=6.850, 4.643, respectively, both P<0.05). Conclusion Hospitals should take effective prevention and control measures based on the characteristics and related risk factors of HAI in patients receiving V-V ECMO treatment to reduce the occurrence of HAI.