| Objective: 1 To investigate the risk factors of death and bloodstream infection in critically ill patients with diabetes mellitus.2.Analysis of distribution and drug resistance of gram negative bacilli in patients with diabetes mellitus.Methods: By means of retrospective intivestigation,the clinical data of 105 cases of ICU critically patients between 2014 June to 2016 May.Inclusion criteria: mechanical ventilation≥48 hours and hospitalization time more than 72 hours.The incidence of bloodstream infections(BSI)compared with severe patients with diabetes and nondiabetics,The mortality compared with severe patients with diabetes and nondiabetics,to explore the relationship between diabetes and mortality in critically ill patients,risk factors of mortality in patients with severe ICU.Objective to investigate the relationship between diabetes and severe patients with bloodstream infections(BSI)and to analyze the risk factors of bloodstream infections(BSI)in patients with severe ICU.Analysis of distribution and drug resistance of gram negative bacilli in ICU patients in our hospital from January 2015 to January 2017.Results: ICU mortality was significantly higher in severe patients with diabetes compared to nondiabetics(χ 2 =3.94 P < 0.05).Diabetes is one of the risk factors of death in patients in ICU,The risk factors for mortality in critically ill patients were age,APACHE II score,cardiovascular disease,hypertension,,chronic kidney disease,sepsis,parenteral nutrition,the difference was statistically significant(P<0.05).In the multivariate analysis showed that sepsis and parenteral nutrition is independent risk factors of death in patients with severe ICU.BSI in severe patients with diabetes was significantly higher than that in nondiabetics(χ2 =4.57,P < 0.05).Diabetes mellitus is one of the risk factors of BSI in severe patients.The risk factors for BSI in critically ill patients were age,BMI,APACHE II score,gender,Hb A1c>7%,cardiovascular disease,chronic kidney disease,cancer,the difference was not statistically significant.(P>0.05).The difference of diabetes mellitus,stroke,and BSI on admission were statistically significant(P< 0.05),The multivariate analysis showed that stroke and BSI on admission is an independent risk factor for BSI in patients in ICU.A retrospective analysis from January 2015 to January 2017 in our hospital patients with severe ICU were isolated from 213 strains of gram negative bacilli,74 strains of diabetic patients with non diabetes patients,139 strains occur in the respiratory tract,urinary tract,blood,catheter.The main pathogens were Pseudomonas aeruginosa(n=55 25.82%),(DM)(n=15),non diabetic(n=40);Klebsiella neumoniae(n=53 24.88%),(DM)(n=26),non diabetic patints(n=27);Bauman Acinetobacter(n=40 18.78%),(DM)(n=15),non diabetic(n=25);Escherichia coli(n=23 10.8%),(DM)(n=6),non diabetic(n=17);Serratia marcescens(n=10 4.69%),(DM)(n=2),non diabetic(n=8);Proteus(n=7 3.29%),(DM)(n=2),non diabetic(n=5);Stenotrophomonas maltophilia(n=7 3.29%),(DM)(n=0)non diabetic(n=7);Enterobacter cloacae(n=5 2.34%),(DM)(n=3)non diabetic(n=2).Multi drug resistant bacteria common,(n=51 23.94%),2 years in patients with diabetes and non diabetes patients with multi drug resistant rate was not statistically significant(χ2=2.53 P>0.05).Pseudomonas aeruginosa were resistant to imipenem and meropenem were 38.18% and 21.82%,Klebsiella pneumoniae were resistant to imipenem and meropenem were 1.89% and 26.42%,Bauman Acinetobacter were resistant to imipenem and meropenem were 52.5% and 95%.Stenotrophomonas maltophilia resistance to carbapenem 100% resistance,But for compound sulfamethoxazole and minocycline sensitive rate can be as high as >90%.Conclusion: diabetes mellitus is one of the risk factors for death and BSI in patients with severe ICU.Sepsis and parenteral nutrition are independent risk factors of death in patients with severe ICU.Stroke and BSI on admission is an independent risk factor for BSI in patients in ICU.t is very important to control multi drug resistant bacteria infection in patients with severe diabetes mellitus.Gram-negative bacteria as the main pathogen of ICU strains have different characteristics of different resistance,should strengthen the detection of drug resistance,to guide the rational use of antibiotics to reduce the incidence of drug-resistant bacteria clinicians. |
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