重症医学科多重耐药菌感染风险因素的网状路径分析

Network path analysis on risk factors for multidrug-resistant organism infection in intensive care unit

摘要:

目的 通过分析重症监护病房（ICU）多重耐药菌（MDRO）感染的风险因素及风险因素之间的内部网络路径，阐明风险因素之间的交互作用，构建ICU MDRO感染的风险模型。方法 回顾分析某三甲医院2019年1—3月综合ICU中所有感染患者，分为MDRO感染组（经临床医生及医院感染监控医生判定为MDRO感染的患者）和非MDRO感染组（未发生MDRO感染的其他感染患者），采用单因素分析法筛选两组间的差异风险因素，利用社会网络分析对差异风险因素进行网状路径分析。结果 共纳入219例感染患者，MDRO感染80例，MDRO感染占所有感染者的36.5%。MDRO感染组的风险因素网络较非MDRO感染组密度更大，风险因素之间的交互作用更强。其中年龄、发热日数、降钙素原异常次数、术后抗菌药物使用日数是MDRO感染的核心风险点，其处于网络图的中心地位（P<0.05）。结论 术后合理使用抗菌药物，将病区内高龄、发热及降钙素原指标异常的患者作为MDRO感染的高危人群，重点关注，实现预防关口前移。

Abstract:

Objective To analyze risk factors and internal network path among risk factors for multidrug-resistant organism (MDRO) infection in intensive care unit (ICU), clarify interaction among risk factors, and construct risk model of MDRO infection in ICU. Methods Patients with infection in the general ICU in a tertiary first-class hospital from January to March 2019 were analyzed retrospectively,they were divided into MDRO infection group (patients with MDRO infection judged by clinicians and HAI surveillance and control doctors) and non-MDRO infection group (patients without MDRO infection but with other infection), univariate analysis was used to screen the diffe-rent risk factors between two groups, social network analysis was used to analyze the network path of different risk factors. Results A total of 219 infected patients were included, 80 of whom were with MDRO infection, accounting for 36.5% of all infected patients. The network of risk factors in MDRO infection group was denser than that of non-MDRO infection group, and the interaction between risk factors was stronger. Among them, age, days of fever, times of abnormal procalcitonin and days of postoperative antimicrobial use were the core risk points of MDRO infection, which were in the center of network diagram (P<0.05). Conclusion Rational use of antimicrobial agents after operation, take the elderly, fever patients and patients with abnormal procalcitonin index as the high-risk popu-lation of MDRO infection and pay attention to them can bring prevention forward.