Analysis Of Clinical Characteristics And Related Risk Factors Of Emergency Septic Patients With Bloodstream Infection

Objective To investigate the distribution and clinical characteristics of pathogens in sepsis patients with emergency bloodstream infection.To find out the related risk factors of sepsis patients with emergency bloodstream infection,and provide a theoretical basis for the early diagnosis and treatment.Methods Patients with sepsis admitted to the emergency department of General Hospital of Ningxia Medical University from October 2017 to October 2020 were retrospectively collected.According to the diagnostic criteria of bloodstream infection,the patients were divided into bloodstream infection group and non-bloodstream infection group.The clinical data of the two groups were collected.Univariate and multivariate logistic regression analysis were used to explore the risk factors of sepsis patients with emergency bloodstream infection,and ROC curve was drawn to predict the occurrence of sepsis patients with emergency bloodstream infection.Results(1)This study included 261 patients with emergency sepsis,110 patients with bloodstream infection group,including 59 males and 51 females,with an average age of 61.05± 13.72 years.There were 151 patients in non-bloodstream infection group,including 87 males and 64 females,with an average age of 61.48±15.54 years.Pulmonary and abdominal infections were the most common sites of infection in both groups.(2)A total of 131 strains of pathogenic bacteria were cultured in patients with bloodstream infection sepsis,including 99 strains of G-bacteria(75.57%),mainly Escherichia coli(46 strains).Escherichia coli and Klebsiella pneumoniae were highly sensitive to amikacin,imipenem and piperacillin tazobactam.32 strains(24.43%)were G+bacteria,mainly Staphylococcus(12 strains).Staphylococcus and Enterococcus were highly sensitive to vancomycin and tigecycline.Fungi 0.(3)The comparison of basic diseases between the two groups of patients with emergency sepsis showed that there was a statistically significant difference in the proportion of solid malignant tumors,diabetes,chronic liver diseases and stone diseases between the two groups(P<0.05).There was a statistically significant difference in the operation history of arteriovenous catheterization,mechanical ventilation and urinary catheter between the two groups(P<0.05).There was a statistically significant difference in the proportion of infection sites in skin and urinary tract infection between the two groups(P<0.05).The comparison of laboratory indexes between the two groups showed that there was a statistically significant difference in SOFA score,PLT,Lac,PCT and TBIL between the bloodstream infection sepsis group and the non-bloodstream infection sepsis group(P<0.05).Multivariate logistic regression analysis showed that urinary tract infection(OR:2.879,95%CI:1.363-6.080)and history of arteriovenous catheterization(OR:3.257,95%CI:1.028-10.317)were independent risk factors for sepsis in patients with emergency bloodstream infection(P<0.05).The higher the SOFA score(OR:1.280,95%CI:1.135-1.443),PCT(OR:1.797,95%CI:1.191-2.710)and TBIL(OR:1.008,95%CI:1.001-1.015),the higher the risk of sepsis in patients with emergency bloodstream infection.The ROC curves showed that the AUCs under the ROC curves of SOFA score,PCT,TBIL,urinary tract infection and history of arteriovenous catheterization were 0.737,0.643,0.634,0.573 and 0.675,respectively.The optimal cutoff value(Cut-off)was calculated by Youden index,which was 7.5 points of SOFA score,10ng/ml of PCT and25.9 μ mol/L of TBIL,respectively.The AUC of five joint prediction was statistically significant compared with those of SOFA score,PCT,TBIL,urinary tract infection and history of arteriovenous catheterization(P<0.01),indicating that the value of five joint prediction in patients with emergency blood flow-induced sepsis was higher than that of SOFA score,PCT,TBIL,urinary tract infection and history of arteriovenous catheterization.Conclusion1.The main infection sites of sepsis in emergency bloodstream infection were lung and abdominal infection.The pathogenic bacteria were mainly G-bacteria,and Escherichia coli was the most common.2.Urinary tract infection and history of arteriovenous catheterization are independent risk factors for sepsis in patients with emergency bloodstream infection.Combined SOFA score,PCT and TBIL have certain predictive value for septic patients with emergency bloodstream infection.