Risk Factors And Prediction Model Of Multidrug Resistant-Acinetobacter Baumannii Infection In ICU Patients With Mechanical Ventilation

Purpose: Objective to explore the infection status and risk factors of MDR-AB in patients with mechanical ventilation in ICU,and to provide clues and scientific basis for exploring effective strategies and measures to prevent and treat MDR-AB infection in patients with mechanical ventilation,so as to improve the prognosis of patients and reduce the economic loss of MDR-AB infection.Methods: In this study,140 patients infected with AB who received mechanical ventilation in the ICU of our hospital from February 2016 to September 2019 were chosen as the research objects,and were divided into the infection group and the control group according to whether the respiratory secretions bacteriological examination results were MDR-AB.All specimens of the patient’s respiratory secretions are artificial airway attract,bronchoscopy and nature in a variety of ways such as sputum samples,once a day,three days,the use of clinical common many kinds of antimicrobial agents,and the results of drug resistance is analyzed,using the single factor and multiple factors Logistic regression analysis of ICU mechanical ventilation in the treatment of infected MDR-AB risk factors,set up to predict ICU mechanical ventilation in patients with infected MDR-AB nomogram risk model,and the nomogram model validation.Results: In the infection group,28 cases(40.00%)were accompanied by more than one other site fungal or bacterial infection,including 2 cases(2.86%)of thoracic infection,2 cases(2.86%)of skin tissue infection,3 cases(4.29%)of abdominal infection,6 cases(8.57%)of urinary system infection,8 cases(11.43%)of central nervous system infection and 7 cases(10.00%)of bloodstream infection.The resistance results of multi drug resistant-Acinetobacter baumannii in the infection group showed: to gentamicin,aztreonam,levofloxacin,ampicillin-sulbactam,piperacillin-tazobactam,eceftriaxon And cefepime,ceftazidime,ceftriaxone and other drug resistance rates are more than 70%,and the drug-resistance rates was96.88% to imipenem and 96.59% to meropenem,Moreover,the drug resistance rates of MDR-AB against cefoperazone-sulbactam and amikacin were 57.82% and 54.62%,among which the lowest drug resistance rates of tigacycline and minocycline were22.25% and 18.96%,respectively.The results of univariate analysis showed that the non-infected group and the infected group were in gender,age,indwelling drainage tube,catheterization,acid inhibitor,nasogastric tube,tracheal intubation,hospitalization history of the past 6 months,brain trauma,surgical operation(Level 2or higher),coronary heart disease and hypertension were not statistically different(P>0.05),but in APACHE II score,mechanical ventilation time,diabetes,tracheotomy,use of glucocorticoids,combination of antibacterial drugs,and pre-infection There were statistical differences in the use of carbapenems and smoking history(P<0.05).With the infection of MDR-AB as the dependent variable,eight statistically significant items(APACHE II score,mechanical ventilation time,diabetes,tracheotomy,use of sugar in the univariate analysis of the infected group and the non-infected group)Corticosteroids,combination of antibacterial drugs,use of carbapenems before infection,smoking history,etc.)were independent variables for multivariate analysis.The results of multivariate logistic regression analysis showed that mechanical ventilation time ≥ 7 days(OR=2.709,95%CI: 1.119～6.562),diabetes(OR=2.663,95%CI: 1.081 ～ 6.555),tracheotomy(OR=3.567),95%CI:1.455 ～ 8.746),use of glucocorticoids(OR=5.442,95%CI: 2.120 ～ 13.972),combination of antibacterial drugs(OR=2.843,95%CI: 1.154～7.002),use of carbon before infection Penicillenes(OR=3.126,95%CI: 1.283 ～ 7.616)and a history of smoking(OR=4.730,95%CI: 1.874 ～ 11.937)are independent risks of MDR-AB infection in mechanically ventilated ICU patients Factors(P<0.05),there are statistical differences.This study is based on seven ICU mechanically ventilated patients with mechanical ventilation time ≥ 7 days,diabetes,tracheotomy,use of glucocorticoids,combination of antibacterial drugs,use of carbapenems before infection,and history of smoking.Independent risk factors for kinesin infection,establish a nomogram model to predict the risk of multi drug resistant-Acinetobacter baumannii infection in mechanically ventilated ICU patients.The established nomogram model was verified,and the predicted values were in good agreement with the measured values,indicating that the established nomogram prediction model has good accuracy in predicting the risk of MDR-AB infection in ICU patients with mechanical ventilation.In addition,in order to further verify the nomogram model of MDR-Ab infection in ICU patients with mechanical ventilation,bootstrap internal validation method was used to verify it,and its C-index was 0.866(95% CI:0.836-0.896),indicating that the accuracy and discrimination of the nomogram model in this study were relatively good.Conclusion: At present,the infection of MDR-AB to patients undergoing mechanical ventilation in our hospital is relatively severe,which deserves the attention of clinicians.Mechanical ventilation time ≥ 7 days,diabetes,tracheotomy,use of glucocorticoids,combination of antibacterial drugs,use of carbapenems before infection,and history of smoking are independent of multi drug resistant-Acinetobacter baumannii infection in ICU mechanically ventilated patients Risk factors.The drug-resistant strains of infected patients may come from the environment,the predictive ability and distinguishing degree of the nomogram model established by the author are relatively accurate.Clinically,relevant prevention and treatment measures can be formulated in combination with the above seven risk factors.