The Distribution Characteristics Of Pathogenic Bacteria And Risk Factors Of Prognosis In Adult Patients With Intra-abdominal Infection In General Hospital

Objective To investigate the distribution characteristics of the pathogenic bacteria and the results of drug sensitivity analysis in patients with intra-abdominal infection,and to provide theoretical basis for the rational selection of anti-infective programs,and to investigate the risk factors of prognosis and its value in assessing prognosis in patients with intra-abdominal infection.Methods Retrospectively,the results of pathogenic bacteria culture and drug sensitivity test and other related clinical data of the patients with intra-abdominal infection were collected in the First Affiliated Hospital of AnHui Medical University from January2012 to December 2016.Exclusion can not be a clear prognosis,the 28-day prognosis for the clinical observation of the end point,and the patients were divided into survival and death groups,and differences between age,sex,underlying disease,pathogenic bacteria type,white blood cell count（WBC）,C-reactive protein（CRP）,procalcitonin（PCT）,albumin levels（ALB）,serum total bilirubin（TBIL）,APACHE II scores and other clinical data were compared between the two groups.Multivariate Logistic regression analysis was used to screen the independent prognostic factors,Spearman correlation analysis was used to evaluate the correlation between the independent prognostic factors and prognosis.The receiver operating characteristic curve（ROC）was drawn to assess the prognostic value of independent factors,the Logistic regression formula was used as model to establish a combined evaluation formula for the prognosis.Results 515 cases of positive culture results were obtained in 4447 cases of intra-abdominal infection specimens,and the positive rate of culture was 11.58%.A total of 559 strains of pathogens,including 347 strains of Gram-negative bacteria（62.08%）,182 strains of Gram-positive bacteria（32.56%）,30 strains of fungi（5.37%）.The top five were Escherichia coli（24.69%）,Acinetobacter baumannii（9.12%）,Klebsiella pneumoniae（8.94%）,Enterococcus faecium（8.05%）,Enterococcus faecalis（4.47%）,Staphylococcus aureus（3.94%）.The extended spectrumβ-lactamas（ESBLs）rates of Escherichia coli and Klebsiella pneumoniae were 65.22%and 20.00%,respectively.The multi-drug resistant strains of Acinetobacter baumannii were 78.43%.Vancomycin resistant strains were detected in Enterococcus faecium（6.67%）,the detection rate of methicillin-resistant Staphylococcus aureus（MRSA）in Staphylococcus aureus was 68.18%,and the detection rate of Methicillin-resistant coagulase-negative staphylococci（MRCNS）was 50.88%.Exclusion can not be a clear prognosis,a total of278 patients were enrolled,including 180 males and 98 females,aged 56.94±15.36years.The survival group was 216 cases,the death group was 62 cases,the total mortality was 22.30%.There were significant differences between the two groups in age,platelet（PLT）,ALB,TBIL,serum creatinine（CR）,APACHE II score,basic cardiovascular disease and diabetes mellitus（P<0.05）,and there was no significant difference in pathogen types,WBC,CRP,PCT and so on（P>0.05）.Spearman correlation analysis showed that ALB was negatively correlated with prognosis,and age,TBIL and APACHE II score were positively correlated with prognosis.Logistic regression analysis showed that age,ALB,TBIL and APACHE II score were independent prognostic factors.The area under the curve（AUC）of the age,ALB,TBIL,APACHE II score and these four combined to assess the prognosis were 0.626,0.702,0.673,0.805 and 0.873 respectively.the sensitivity was 56.45%,59.68%,41.94%,79.03%and 91.94%respectively,and the specificity was 68.98%,75.00%,85.65%,69.44%and68.98%,respectively.The formula of age combined ALB,TBIL and APACHE II score was Y=X₁-2.9X₂+0.2X₃+4.8X₄（X₁ was the age,X₂ was the ALB,X₃ was the TBIL,and X₄ was the APACHE II score）,Y was positively correlated with poor prognosis,and the optimal cutoff value was Y=47.88.Conclusion 1.The main pathogens of intra-abdominal infection is Gram negative bacteria.The top six pathogens are Escherichia coli,Acinetobacter baumannii,Klebsiella pneumoniae,Enterococcus faecium,Enterococcus faecalis and Staphylococcus aureus.The overall drug resistance of intra-abdominal infection is serious.The different types of pathogens do not affect the overall prognosis of patients with intra-abdominal infection.2.Age,ALB,TBIL and APACHE II score are independent factors which influencing the prognosis of patients with intra-abdominal infection,The formula for assessing prognosis by combining age,ALB,TBIL,and APACHE II scores is Y=X₁-2.9X₂+0.2X₃+4.8X₄（X₁ was the age,X₂ was the ALB,X₃ was the TBIL,and X₄ was the APACHE II score）.Y is positively correlated with poor prognosis,and the optimal cutoff value was Y=47.88.Y（the combination of age,ALB,TBIL and APACHE II score）can better assess the prognosis of intra-abdominal infection.