摘要
目的分析消化急诊科危重症患者并发院内真菌感染的临床特征及影响因素。方法选取空军军医大学第一附属医院消化急诊科自2019年3月至2024年3月收治的623例危重症患者为研究对象。记录患者真菌感染检出情况及临床特征,采用Logistic回归分析消化急诊科危重症患者并发院内真菌感染的影响因素,根据影响因素构建回归预测模型,应用受试者工作特征(ROC)曲线及H-L检验评估预测模型的预测价值、一致性。结果623例患者中,51例(8.19%)并发院内真菌感染(真菌感染组),572例(91.81%)未并发院内真菌感染(无真菌感染组);感染检出部位以腹腔感染最多;真菌感染组共分离出58株真菌菌株,主要为白假丝酵母菌。合并糖尿病、侵入性操作、抗菌药物联用、急性生理与慢性健康Ⅱ评分、C反应蛋白与白蛋白比值是消化急诊科危重症患者并发院内真菌感染的影响因素(P<0.05)。根据影响因素建立消化急诊科危重症患者并发院内真菌感染的回归预测模型,该模型预测并发院内真菌感染的ROC曲线下面积为0.878(95%可信区间:0.821~0.935,P<0.05),敏感度为76.47%,特异度为88.64%,且预测模型与实际观测结果具有较好的一致性。结论消化急诊科危重症患者并发院内真菌感染以白假丝酵母菌最为常见,且多发于腹腔,合并糖尿病、侵入性操作、抗菌药物联用、急性生理与慢性健康Ⅱ评分、C反应蛋白与白蛋白比值为消化急诊科危重症患者并发院内真菌感染的影响因素,根据以上因素构建的回归预测模型在预测并发院内真菌感染方面具有较高的应用价值。
Objective To analyze the clinical features and influencing factors of nosocomial fungal infection in critically ill patients in digestive emergency department.Methods A total of 623 critically ill patients admitted to the Emergency Department of Gastroenterology in the First Affiliated Hospital of Air Force Medical University from March 2019 to March 2024 were selected as the study objects.The detection of fungal infection and clinical characteristics of patients were recorded,and the influencing factors of nosocomial fungal infection in critically ill patients in the department of digestive emergency were analyzed by Logistic regression.The regression prediction model was constructed according to the influencing factors,and the predictive value and consistency of the prediction model were evaluated by receiver operating characteristic(ROC)curve and H-L test.Results Among the 623 patients,51(8.19%)had nosocomial fungal infection(fungal infection group)and 572(91.81%)had no nosocomial fungal infection(no fungal infection group).Abdominal cavity infection was the most common infection site.In the fungal infection group,58 fungal strains were isolated,mainly Candida albicans.The factors influencing nosocomial fungal infection were diabetes,invasive procedure,combination of antibiotics,acute physiological and chronic healthⅡscores,C-reactive protein to albumin ratio(P<0.05).A regression prediction model for nosocomial fungal infection in critically ill patients in the department of Digestive emergency was established according to the influencing factors.The area under ROC curve of this model for predicting nosocomial fungal infection was 0.878(95%confidence interval 0.821-0.935,P<0.05),the sensitivity was 76.47%,and the specificity was 88.64%.The predicted model is in good agreement with the actual observation results.Conclusion Candida albicans is the most common form of nosocomial fungal infection in critically ill patients in the department of digestive emergency department,and it mostly occurs in the abdominal
作者
杨苗
陈彦子
郭蕾
路伟
YANG Miao;CHEN Yan-zi;GUO Lei;LU Wei(Department of Gastroenterology,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China)
出处
《创伤与急危重病医学》
2024年第4期237-241,共5页
Trauma and Critical Care Medicine
关键词
重症监护
真菌感染
影响因素
Intensive care
Fungal infection
Influencing factor
