重症颅脑损伤患者合并多重耐药菌肺部感染病原菌分布、影像学特征以及风险预测模型的建立与验证
Pathogen Distribution,Imaging Characteristics,and Establishment and Verification of Risk Prediction Model of Pulmonary Infection with Multi-drug Resistant Organism in Patients with Severe Craniocerebral Injury
查看参考文献30篇
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文摘
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目的调查重症颅脑损伤患者多重耐药菌(MDRO)肺部感染病原菌分布、影像学特征并分析其危险因素,建立和验证风险预测模型。方法回顾性收集发生肺部感染的重症颅脑损伤患者230例,按照7∶3比例原则,随机分为建模组(161例)和验证组(69例),利用建模组数据分析重症颅脑损伤MDRO肺部感染危险因素并建立风险预测模型,利用验证组数据验证模型效能。结果230例患者中68例发生MDRO肺部感染,分离的耐药菌主要包括多重耐药鲍曼不动杆菌、多重耐药肺炎克雷伯菌、多重耐药铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌,分别占45.21%、23.29%、16.44%、 15.07%。影像学表现多见胸腔积液、肺实变、磨玻璃影,分别占72.06%、63.24%、45.59%。多因素Logistic回归分析显示,年龄≥60岁(P = 0.003) 、糖尿病病史(P = 0.021) 、慢性阻塞性肺疾病病史(P = 0.038) 、机械通气≥7 d (P = 0.001) 、外院转入(P = 0.008)以及昏迷(P = 0.002)是建模组患者发生MDRO肺部感染的独立危险因素。利用回归方程中各指标对应的β值,四舍五入取整,建立风险评分模型,其中年龄≥60岁、糖尿病病史、慢性阻塞性肺疾病病史、机械通气≥7 d、外院转入以及昏迷风险评分对应的分值分别是1、1、1、2、2、1分,该模型在建模组和验证组中的受试者工作特征曲线下面积分别为0.845、0.809,其中≥4分为高风险人群。结论重症颅脑损伤MDRO肺部感染病原菌以多重耐药鲍曼不动杆菌为主,影像学检查多见胸腔积液、肺实变和磨玻璃影,构建的风险评分模型在建模组和验证组均具有较高的判别效度。 |
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其他语种文摘
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Objective To investigate the pathogen distribution,imaging characteristics,and risk factors of pulmonary infection with multi-drug resistant organism (MDRO) in patients with severe craniocerebral injury, and establish and verify the risk prediction model. Methods A total of 230 patients with severe craniocerebral injury complicated with pulmonary infection were collected retrospectively. According to the 7∶3 ratio,they were randomly assigned into a modeling group (161 patients) and a validation group (69 patients). The risk factors of MDRO pulmonary infection were predicted with the data of the modeling group for the establishment of the risk prediction model. The data of the validation group was used to validate the performance of the model. Results Among the 230 patients,68 patients developed MDRO pulmonary infection. The isolated drug-resistant bacteria mainly included multi-drug resistant Acinetobacter baumannii,multi-drug resistant Klebsiella pneumoniae,multidrug resistant Pseudomonas aeruginosa,and methicillin-resistant Staphylococcus aureus,which accounted for 45.21%,23.29%,16.44%,and 15.07%,respectively. The imaging characteristics included pleural effusion, lung consolidation,and ground-glass shadow,which accounted for 72.06%,63.24%,and 45.59%, respectively. Multivariate Logistic regression analysis showed that the independent risk factors for MDRO pulmonary infection included age ≥60 years (P = 0.003),history of diabetes (P = 0.021),history of chronic obstructive pulmonary disease (P = 0.038),mechanical ventilation ≥7 d (P = 0.001),transfer from other hospitals (P = 0.008),and coma (P = 0.002). A risk scoring model was established with the β value (rounded to the nearest integer) corresponding to each index in the regression equation. Specifically,the β values of age ≥60 years, history of diabetes,history of chronic obstructive pulmonary disease,mechanical ventilation ≥7 d,transfer from other hospitals,and coma were 1,1,1,2,2,and 1,respectively (value ≥4 indicated a high-risk population). The areas under the receiver operating characteristic curve of the modeling group and validation group were 0.845 and 0.809,respectively. Conclusions Multi-drug resistant Acinetobacter baumannii is the most common pathogen of MDRO pulmonary infection in patients with severe craniocerebral injury. Pleural effusion, lung consolidation,and ground-glass shadow were the most common imaging characteristics. The established risk model has high discriminant validity in both the modeling group and the validation group. |
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来源
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中国医学科学院学报
,2022,44(4):636-642 【核心库】
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DOI
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10.3881/j.issn.1000-503X.14670
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关键词
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重症颅脑损伤
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多重耐药菌
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肺部感染
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影像学特点
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风险评分
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地址
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湖州南太湖医院放射科, 浙江, 湖州, 313000
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湖州南太湖医院神经医学中心, 浙江, 湖州, 313000
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湖州南太湖医院感控科, 浙江, 湖州, 313000
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陆军第72集团军医院放射科, 浙江, 湖州, 313000
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语种
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中文 |
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文献类型
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研究性论文 |
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ISSN
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1000-503X |
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学科
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外科学 |
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文献收藏号
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CSCD:7291123
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参考文献 共
30
共2页
|
|
1.
赵建兰. 老年肺部感染住院患者多药耐药菌感染影响因素的回顾性调查.
中华医院感染学杂志,2019,29(6):835-838
|
被引
6
次
|
|
|
|
|
2.
杨倩. 老年肺部感染患者死亡的危险因素.
中华急诊医学杂志,2020,29(4):582-585
|
被引
4
次
|
|
|
|
|
3.
葛歆瞳. 神经重症患者感染诊治:美国临床神经医学手册(2017-2018)与中国专家共识(2017)的对比与解读.
中华神经医学杂志,2019,18(1):2-11
|
被引
3
次
|
|
|
|
|
4.
李静. 医院感染细菌性肺炎患者多重耐药菌感染及30 d死亡危险因素分析.
检验医学,2019,34(4):300-304
|
被引
2
次
|
|
|
|
|
5.
徐雅萍. MDR,XDR,PDR细菌:国际专家关于获得性耐药暂行定义的提案.
中华医院感染学杂志,2017,27(1):231-240
|
被引
13
次
|
|
|
|
|
6.
黄兰清. 儿童重症监护室多重耐药菌感染情况及危险因素.
中华医院感染学杂志,2020,30(9):1436-1440
|
被引
1
次
|
|
|
|
|
7.
向辉. 重症监护室老年患者下呼吸道感染多重耐药肺炎克雷伯杆菌的危险因素及预后.
中国老年学杂志,2019,39(17):4206-4210
|
被引
3
次
|
|
|
|
|
8.
韩静静. 多重耐药菌导致呼吸机相关性肺炎的危险因素及病原菌分析.
医药导报,2019,38(10):1335-1338
|
被引
4
次
|
|
|
|
|
9.
陈国建. 某综合医院常见多重耐药菌感染危险因素Logistic回归分析.
华西医学,2020,35(3):290-295
|
被引
3
次
|
|
|
|
|
10.
中华医学会呼吸病学分会. 肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版).
中华结核和呼吸杂志,2017,40(8):578-583
|
被引
50
次
|
|
|
|
|
11.
黄文婷. ICU患者多药耐药菌感染的影响因素分析.
中华医院感染学杂志,2019,29(21):3246-3250
|
被引
2
次
|
|
|
|
|
12.
苏艳丽. 神经外科重症监护室病房患者多重耐药菌感染的危险因素分析.
中国医师杂志,2019,21(12):1837-1840
|
被引
3
次
|
|
|
|
|
13.
姚丹玲. 耐碳青霉烯鲍曼不动杆菌耐药机制研究进展.
国外医药抗生素分册,2020,41(1):11-16
|
被引
1
次
|
|
|
|
|
14.
胡付品. 2017年CHINET中国细菌耐药性监测.
中国感染与化疗杂志,2018,18(3):241-251
|
被引
251
次
|
|
|
|
|
15.
罗可人. 肺炎克雷伯菌抗生素耐药性的研究进展.
中国抗生素杂志,2020,45(6):540-544
|
被引
2
次
|
|
|
|
|
16.
胡付品. 2019年CHINET三级医院细菌耐药监测.
中国感染与化疗杂志,2020,20(3):233-243
|
被引
112
次
|
|
|
|
|
17.
Dean Nathan C. Pleural effusions at first ED encounter predict worse clinical outcomes in patients with pneumonia.
Chest,2016,149(6):1509-1515
|
被引
5
次
|
|
|
|
|
18.
路素坤. 儿童肺炎支原体感染呈肺实变的临床分析.
河北医学,2018,24(1):43-46
|
被引
1
次
|
|
|
|
|
19.
曹桂花. 高龄肺部感染患者多重耐药菌的分布及临床特点.
中华老年多器官疾病杂志,2018,17(10):753-756
|
被引
3
次
|
|
|
|
|
20.
绳凤. 老年患者多重耐药菌肺部感染危险因素.
中国感染控制杂志,2015,14(10):701-704
|
被引
1
次
|
|
|
|
|
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