Investigation Of Multi-drug Resistant Organism In Intensive Care Units And Logistic Analysis Of Risk Factors

Bacterial infection is still one of the major causes of high morbidity and mortality inthe world.The widespread use of antibiotics provides environment and motivation for bacterial resistance.Although the intensive care unit provides emergency and continuous life support for critically patients,the increasing using of the antibacterial drugs lead bacterial resistance continues to develop,the resistance rate of bacterial in intensive care units exceeds the overall level of drug resistance of nosocomial pathogens.Furthermore,with the extensive use of invasive examinations and treatment methods,the unreasonable use of broad-spectrum antibacterial drugs and immunosuppressant,the increase of the degree of patients'age,pathogenic bacteria presents not only highly resistant but also multi-drug resistant,the intensive care unit also become the department with the highest detection rate of multi-drug resistant infections in the hospital.The breeding,colonization,transmission,and infection of multi-drug resistant bacteria become a hidden danger in hospital infections and a serious public health and safety problem in the world.The control of multi-drug resistant infections needs to base on the local epidemiological studies to grasp the dynamic changes of local bacterial resistance.ObjectiveTo browse patients with nosocomial infection and multidrug-resistant infections inthe intensive care unit of a tertiary general hospital,collect medical records,browse independent risk factors for multidrug-resistant infections in hospitals,and explore to build an early warning model to predict the risk of multi-drug resistant hospital infections in intensive care units.MethodA total of 474 patients with in-hospital infections from Central,Respiratory,Neurology,and Emergency Intensive Care Units of the Renmin Hospital of Wuhan University from 1 January 2015 to 31 December 2016 are selected for study.Review the complete medical records and use retrospective study to investigate and collect medical records and data.SPSS 24.0 software is used for data analysis.Logistic regression analysis is used to perform univariate and multivariate screening for multi-drug resistant independent risk factors.An infection risk alert model is constructed and tested.Results(1)From January 1,2015 to December 31,2016,474 cases of nosocomial infection are investigated,239 cases are non-multidrug resistant infection group,235 cases are infection group,the average age are about 60 years old with a large proportion of men.A total of 581 multi-drug resistant strains are detected,which 511(87.95%)are Gram-negative multi-drug resistant strains.The proportion of Acinetobacter baumannii is the highest(63.86%),then the proportion of Staphylococcus aureus.and Pseudomonas aeruginosa are 11.88%and 10.15%.The sputum specimens are main isolates of the strains(507 strains,87.26%),the urine(38 strains,6.54%)and blood cultures(10 strains,1.72%)are remaining strains.Drug susceptibility test results show that Acinetobacter baumannii,Staphylococcus aureus,and Pseudomonas aeruginosa are resistant to ampicillin,gentamycin,amikacin,ciprofloxacin,cotrimoxazole,and tetracycline.(2)Univariate analysis shows that total days of hospitalization,length of ICU stays,artificial airway time,indwelling catheter time,indwelling gastric tube time,central venous catheterization time,mechanical ventilation time,days of antibiotic use and types of antibiotics are related to multidrug resistant infections.Patients aged 45 to 64years(OR=2.300,95%CI 1.381,3.830)are most strongly associated with multi-drug resistant organism infection.Hospitalizations accounted for the largest proportion within the range of 30-59 days(OR=2.375,95%CI 1.250,4.513),and the number of patients with ICU admission for 15-29 days is the highest(OR=3.667,1.391,9.669).The chance of infection of multi-drug resistant organism in artificial airways for 15-30days is 1.471 times less than 7 days;multi-drug resistant organism of indwelling urinary ducts and gastric tubes in 8-14 days is 3.385 and 2.393 times less than 7 days;central venous catheters 15-30 Days infected with multi-drug resistant organism are 1.753times less than 7 days;mechanical ventilation 8-14 days is 3.912 times less than 7 days of infection with multi-drug resistant organism.The use of antibiotics to infect multi-drug resistant organism for 8-14 days is 2.864 times less than 7 days,and the use of triple antibiotics is 4.312 times less than antibiotics.(3)Multivariate analysis show that age(45-65 years),total length of hospital stay(30-59 days),ICU length of stay(15-29 days),artificial airway time(8-14 days),indwelling catheter Time(8-14 days),central venous catheterization(15-30 days),mechanical ventilation(8-14 days)and antibiotics(triples)are independent risk factors of the final retention of multidrug resistant infections in intensive care units.The resulting early warning model equation is:Logistic(P)=-4.665+0.689Age+0.533Total length of hospital stay+1.715Length of ICU stay+1.906Artificial airway time+2.050Indwelling catheter time+1.249Mechanical ventilation time+1.456Antibiotic type.(4)Using the likelihood ratio chi-square test(?~2=487.594,DF=23,p<0.0001)and Wald test(?~2=169.475,DF=23,p<0.0001)to test the total validity of the model.Hosmer&Lemeshow(chi-square=12.786,DF=8,p=0.119)is used to test the goodness of fit,the model fitted well(p>0.05),and the AUC under the ROC curve is 0.831(95%CI 0.794,0.86),with a sensitivity of 99.2%and a specificity of 85.1%,this model has a good discriminative effect and has clinical significance.ConclusionThe form of drug resistance in the intensive care unit is severe,active prevention and control and intervention measures should be taken.By exploring and establishing an early warning model of infection,the infection of multiple drug resistant bacteria can be effectively prevented and controlled.