| Background: MDRO infection has become a major global public health problem,causing significant health and economic burden to patients,and seriously threatening the patient safety.Thus,exploring the influencing factors of MDRO nosocomial infection plays an important role in their prevention and control.Objective: A retrospective study was conducted in intensive care unit(ICU)to understand the prevalence of hospital-acquired lower respiratory tract infection with MDRO and to identify the influencing factors of hospital-acquired lower respiratory tract infection caused by MDRO.Methods: This study was conducted on inpatients in ICU of a tertiary general hospital with hospital-acquired lower respiratory tract infection from January 1,2016 to December 31,2020.A retrospective study was conducted to collect patients’ hospitalization information about their diagnosis,test results,treatment and invasive procedures using a self-made information collection sheet for lower respiratory tract hospital infection as a research tool.The quantitative data were first tested for Kolmogorov-Smirnov normality test,and those following normal distribution were presented using mean±standard deviation( ± ),and between-groups comparisons used ANOVA analysis with a post-hoc LSD test;The quantitative data not following normal distribution were expressed as median and quartile,and the Kruskal-Wallis H test was used for comparison between groups.The qualitative data were presented as frequency and percentage,and the Kruskal-Wallis H test was used for comparison between groups.Correlations between variables were analyzed using Spearman correlation.Multivariate analysis was performed by logistic regression in the generalized linear model to determine the influencing factors.Results: A total of 221 patients with hospital-acquired lower respiratory tract infection in ICU were enrolled,and the prevalence of non-multidrug resistant bacteria infection,multidrug-resistant bacteria infection,and extensively drug-resistant bacteria infection were 42.53%(94/221),31.22%(69/221),and 26.24%(58/221),respectively.The top three pathogens among253 strains detected from 221 patients were: Acinetobacter(93,36.76%),Klebsiella(36,14.23%)and Pseudomonas aeruginosa(26,10.28%).The univariate analysis showed that between the non-multidrug resistant group,the multidrug-resistant group and the extensively drug-resistant group,significant differences were found in the Hemoglobin deviation values(F=4.635,P=0.011),Minimum serum albumin value(F=5.309,P=0.006),Initial serum albumin value(H=6.339,P=0.042),Length of stay in the ICU(H=7.784,P=0.020),Duration of indwelling tracheal tube(H=8.210,P=0.016),Duration of ventilator use(H=10.476,P=0.005),Duration of indwelling deep vein catheter(H=8.535,P=0.014),Duration of indwelling urinary catheter(H=7.807,P=0.020),Duration of indwelling nasogastric tube(H=7.571,P=0.023),Days of antibiotic therapy(H=10.573,P=0.005),Days of glucocorticoid therapy(H=7.090,P=0.029),Days of sedative drug therapy(H=10.861,P=0.004),Days of human blood albumin therapy(H=16.712,P<0.001),Time to start using human human albumin(H=7.479,P=0.024),Use of carbapenems(H=8.733,P=0.013),Use of quinolones(H=10.536,P=0.005),Use of vancomycins or linezolid(H=12.350,P=0.002),Number of species of antibiotics used(H=9.804,P=0.007),Frequency of blood transfusion(H=11.369,P=0.003),Endotracheal tube replacement or reintubation(H=6.332,P=0.042)and the Inverted albumin-globulin ratio(A/G)(H=10.896,P=0.004).The multivariate analysis showed:(1)the independent risk factors for lower respiratory tract hospital infections with higher levels of drug-resistant pathogens in ICU patients were the Inverted A/G [OR=2.02,95%CI(1.13,3.60),P=0.017],Endotracheal tube replacement or reintubation [OR=2.10,95%CI(1.16,3.81),P=0.015],Use of quinolones[OR=4.14,95%CI(1.30,13.19),P=0.016] and Use of vancomycin or linezolid[OR=3.00,95%CI(1.20,7.49),P=0.019].(2)Using the non-multidrug resistant group as a control,the independent risk factors for lower respiratory tract hospital infections with multidrug-resistant bacteria were the Endotracheal tube replacement or reintubation [OR=2.24,95%CI(1.05～4.80),P=0.037]and Use of carbapenems [OR=3.76,95%CI(1.46～9.69),P=0.006].Relative to not using human albumin before diagnosis,starting human albumin within 3days [OR=0.37,95%CI(0.15-0.90),P=0.028] was a protective factor of multidrug-resistant bacteria infections.(3)Using the non-multidrug resistant group as a control,the independent risk factors for lower respiratory tract hospital infections with extensively drug-resistant bacteria were the Use of quinolones [OR=7.64,95%CI(1.08～54.07),P=0.042],Use of vancomycin or linezolid [OR=5.68,95%CI(1.41～22.85),P=0.014],and the Inverted A/G[OR=3.22,95%CI(1.24～8.37),P=0.016].(4)Using the multidrug resistant group as a control,the independent risk factors for lower respiratory tract hospital infections with extensively drug-resistant bacteria were the Use of vancomycin or linezolid [OR=5.44,95%CI(1.12～26.39),P=0.035],the Inverted A/G [OR=3.74,95%CI(1.21～11.54),P=0.022],Extended ventilator use time [OR=1.16,95%CI(1.01～1.32),P=0.037],and Extended duration of glucocorticoid use [OR=1.20,95%CI(1.01～1.44),P=0.042].Relative to the frequency of transfusion ≥ 3 times,the absence of transfusion before diagnosis [OR=0.08,95%CI(0.01～0.57),P=0.011] and the number of transfusion 1 to 2 times [OR=0.06,95%CI(0.01～0.45),P=0.006] were protective factors of extensively drug-resistant bacteria infections.Conclusion: MDROs are the main pathogens of hospital-acquired lower respiratory tract infections in ICU patients.Endotracheal tube replacement or reintubation,frequency of transfusion≥3 times,Extended ventilator use time,Use of quinolones,Use of vancomycins or linezolid,Extended duration of glucocorticoid use and the Inverted A/G were independent risk factors for lower respiratory tract hospital infections with multidrug-resistant bacteria or extensively drug-resistant bacteria in ICU patients.In the prevention and control of MDRO hospital-acquired lower respiratory tract infection,it is suggested that clinical nursing staff focus on patients with the inverted A/G,transfusion,indwelling endotracheal intubation,use of ventilator,use of quinolones,vancomycins or linezolid,glucocorticoid,strengthen nursing management,implement infection prevention and control measures,and reduce the risk of lower respiratory tract hospital infections caused by MDRO in ICU patients.8 Figures,27 Tables,117 References... |
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