| Objection:Patients with severe burns are at high risk of developing systemic bloodstream infections,with Acinetobacter baumannii(Ab)being particularly common.With the massive application of antibiotics in clinical practice in recent years,and the outstanding ability of Ab resistance and clonal transmission,the situation of Ab resistance has become more and more serious,especially the increasing number of bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii(CRAB),and the high morbidity and mortality rate.The emergence of drug-resistant Ab not only makes it more difficult to treat patients with severe burns,but also increases the length of hospitalization,treatment costs and adverse prognosis.The aim of this research was to discuss the hazard factors for Ab bleeding infection in severely burned patients and to analyze the prognosis of patients with CRAB bleeding infection and to evaluate the ability of infection-related indicators to predict the prognosis of severely burned patients with CRAB bleeding infection.Methods:Retrospective analysis of 102 patients with severe burns diagnosed with Ab bloodstream infection from January 2014 to December 2021 at our burn plastic and trauma restoration medical center as a case group and a control group selected according to 1:1 matching,and risk factors for Ab bloodstream infection were analyzed using univariate and multifactorial conditional logistic regression models.Patients with CRAB bloodstream infection in the case group were selected and categorized into adverse prognosis group and positive prognosis group based on their prognosis.Hazard factors associated with adverse prognosis were investigated by comparing the clinical data of the two groups,and the prognostic ability of the prognosis of patients with CRAB bloodstream infection was evaluated by comparing the infection-related indexes of the two groups within 48 hours after diagnosis using the subject operating characteristic curve(ROC curve).Results:(1)Analysis of the case and control groups showed that mechanical ventilation(OR=4.079,95%CI: 1.239-13.427,P=0.021),arterial placement(OR=8.678,95%CI:1.000-75.322,P=0.049)and the combination of other areas of Ab infection(OR=5.472,95%CI: 1.057-28.327,P=0.043)were the independent factors of danger for Ab bleeding infection in severely burned patients and above.(2)Comparison between the positive prognosis group and the adverse prognosis group showed that prolonged mechanical ventilation(OR=1.068,95%CI: 1.018-1.121,P=0.007),large III° burn area(OR=1.081,95%CI: 1.034-1.130,P=0.001)and advanced age(OR=1.074,95%CI: 1.014-1.137,P=0.015)were independent factors influencing the poor prognosis of patients with CRAB bloodstream infection burns.(3)The comparison of test indicators related to infection within 48 hours of diagnosis in patients with CRAB bloodstream infection burns showed that platelet(PLT)was markedly less in the adverse prognosis group than the positive prognosis group,and the discrepancy was statistically meaningful(Z=-4.2,P<0.001);while procalcitonin(PCT)and D-dimer were significantly higher in the adverse prognosis group than in the positive prognosis group(P<0.050).The results of multifactorial approach indicated a significantly lower PLT(P=0.002,OR=0.98)and a significantly higher PCT(P=0.042,OR=1.219)in the adverse prognosis group.(4)The results of ROC curve analysis of PLT,PCT and PLT combined with PCT to predict poor prognosis in CRAB bloodstream infected burn patients showed that the region under the ROC circle for PLT was 0.779(95% CI: 0.677-0.88,P<0.001),and the Youden index was the maximal at 0.492 when the truncation value was taken as 157.5*109/L,with a sensitivity of 83.3% and specificity of 65.9%.The PCT region under the ROC curve is0.720(95% CI: 0.604-0.836,P=0.001),and when the truncation value was taken as7.42ng/ml,the Youden index was the maximal at 0.42,with a sensitivities of 55.6%and specificities of 86.4%.The region under the ROC curve for PLT combined with PCT was 0.836(95% CI: 0.750-0.923,P<0.001),with an optimal threshold of-44.588,sensitivity of 69.4%,specificity of 86.4% and Youden index of 0.558.Conclusions:Mechanical ventilation,arterial placement and combined Ab infections at other sites are independent risk factors for Ab bloodstream infections in patients with severe burns and beyond.(2)Prolonged mechanical ventilation,large area of III°burns and advanced age as factors influencing adverse prognosis of burn patients with CRAB bloodstream infection.(3)Both PLT and PCT have some function in predicting the prognosis of patients with CRAB bleeding infections.When patients have reduced PLT or high PCT,it indicates poor prognosis. |
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