Risk Factors And Short-term Prognosis Of XDRAB Ventilator-associated Pneumonia In Patients With Mechanical Ventilation

ObjectivesTo investigate the current status and risk factors of Extensively Drug Resistant Acinetobacter Baumannii Ventilator-associated Pneumonia(XDRAB-VAP)in patients with mechanical ventilation in intensive care unit(ICU),and assessing short-term prognosis and hospitalization costs for patients with XDRAB-VAP.In order to determine the key nursing targets of mechanical ventilation,and improve the nurses'awareness of prevention and control,and formulate a sound prevention and control strategy for ICU infection and rational allocation of medical resources.MethodUsing cluster sampling methods.According to the inclusion and exclusion criteria,the mechanical ventilation patients admitted to a top three hospital ICU from June 2016 to June 2018 were retrospectively recruited.The self-designed medical record collection table"XDRAB-VAP risk factors questionnaire for ICU mechanical ventilation patients"and"Short-term prognosis and hospitalization expense questionnaire for XDRAB-VAP in ICU mechanical ventilation patients"were used to collect the necessary information through the hospital medical record system.According to whether XDRAB-VAP occurred or not,it was divided into XDRAB-VAP group and non XDRAB-VAP group.SPSS 22.0 software was used to analyze risk factors and their predictive value.Using R 3.5.1 software to perform propensity score weighted balance confounding factors,logistic regression analysis was used to analyze short-term prognosis,the difference of hospitalization days or hospitalization costs was compared using the rank sum test.Results1.A total of 491 patients with mechanical ventilation were included.There were 336 males(68.4%)and 155 females(31.6%)with the average age of 60.20117.19 years,including 133 cases in the XDRAB-VAP group and 358 cases in the non XDRAB-VAP group.The incidence of XDRAB-VAP was 27.1%.2.A total of 219 strains of XDRAB were detected,including 133 strains of infectious bacteria(60.7%)and 86 strains of colonization bacteria(39.3%).The resistance rates of commonly used antibiotics were at a high level,and only resistance to tigecycline was Lower(7.5%).3.General data comparison indicate that:there was statistically significant difference in the way of ICU admission,ICU major diagnosis,tumor,diabetes,chronic lung disease,renal insufficiency,smoking history,hospital history,tracheotomy,mechanical ventilation time,acute physiology and chronic health score(APACHE II score),systemic infection-related organ failure score(SOFA score),lower respiratory tract combined with fungal colonization,broad-spectrum antibiotic treatment>7 days,combination of antibiotics>2,glucocorticoid therapy>3 days,renal replacement therapy,infection index(neutrophil ratio,procalcitonin,C-reactive protein)(P<0.05).There was no statistically significant difference in other factors(P>0.05).4.Logistic regression analysis results showed that mechanical ventilation time(OR=1.070,95%CI:1.033?1.109),APACHE II score(OR=1.047,95%CI:1.009?1.086),combination of antibiotics>2(OR = 4.703,95%CI:2.690?8.222),glucocorticoid treatment>3 days(OR = 3.188,95%CI:1.681?6.047),tracheotomy(OR = 2.534,95%CI:1.424-4.510)were the independent risk factors of XDRAB-VAP among ICU patients with mechanical ventilation.5.ROC curve analysis showed that the curve area(AUC)of mechanical ventilation time,APACHE II score,combination of antibiotics>2,glucocorticoid treatment>3 days,tracheotomy were 0.764,0.690,0.752,0.602,0.631 respectively,in which the optimal cutoff value of mechanical ventilation time was 6.5(sensitivity:0.729,specificity:0.704);the best cutoff value of APACHE II score was 11.5(sensitivity:0.857,specificity:0.433).6.Using short-term prognosis(survival group,death group)as the dependent variable,XDRAB-VAP and those confounding factors influencing prognostic as independent variables,construct general logistic regression equation and propensity score weighted logistic regression equation,two methods shown that XDRAB-VAP was a risk factor for adverse short-term prognosis for ICU hospitalized patients(OR=3.327,95%CI:1.663?6.429,P=0.001)/(OR=3.874,95%CI:1.978?7.588,P<0.001).7.After the propensity score weighted equilibrium confounding factor,the rank sum test showed that the ICU hospital stay days of XDRAB-VAP group was longer than the non XDRAB-VAP group,and the difference was statistically significant(p<0.05),but there was no statistically significant in total hospital stays between the two groups(P>0.05).The total hospitalization cost in the XDRAB-VAP group was higher than that of the non XDRAB-VAP group(P<0.05),and it was higher than the non XDRAB-VAP group in the three aspects of drug,examination and treatment(P<0.05),but there was no difference in the cost of nursing and consumables(P>0.05).Conclusions1.The incidence of XDRAB-VAP is high,and the choice of antibiotic treatment is very limited,so it should be highly valued.2.The risk factors of XDRAB-VAP for ICU patients with mechanical ventilation are not specific,but the mechanical ventilation time>7 days,combination of antibiotic>2 have a good predictive value for predicting XDRAB-VAP,guiding nurses to identify the key care targets for mechanical ventilation patients and adopt targeted infection prevention and control strategies.3.XDRAB-VAP increased the risk of short-term adverse prognosis and hospitalization economic burden of patients,and the cost of drug accounted for the highest proportion,but the difference of cost between the nursing and consumables was small.Therefore,ICU should increase resource input and management in the prevention and control of ICU infection,and promote the formulation of standardized and accurate charging standards.