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基于限制性立方样条模型分析肺移植受者多重耐药菌感染的危险因素

仇桑桑, 许琴芬, 陈静瑜, 等. 基于限制性立方样条模型分析肺移植受者多重耐药菌感染的危险因素[J]. 器官移植, 2023, 14(4): 578-584. doi: 10.3969/j.issn.1674-7445.2023.04.015
引用本文: 仇桑桑, 许琴芬, 陈静瑜, 等. 基于限制性立方样条模型分析肺移植受者多重耐药菌感染的危险因素[J]. 器官移植, 2023, 14(4): 578-584. doi: 10.3969/j.issn.1674-7445.2023.04.015
Qiu Sangsang, Xu Qinfen, Chen Jingyu, et al. Analysis of risk factors of multidrug-resistant organism infection in lung transplant recipients based on restricted cubic spline model[J]. ORGAN TRANSPLANTATION, 2023, 14(4): 578-584. doi: 10.3969/j.issn.1674-7445.2023.04.015
Citation: Qiu Sangsang, Xu Qinfen, Chen Jingyu, et al. Analysis of risk factors of multidrug-resistant organism infection in lung transplant recipients based on restricted cubic spline model[J]. ORGAN TRANSPLANTATION, 2023, 14(4): 578-584. doi: 10.3969/j.issn.1674-7445.2023.04.015

基于限制性立方样条模型分析肺移植受者多重耐药菌感染的危险因素

doi: 10.3969/j.issn.1674-7445.2023.04.015
基金项目: 

江苏省科技重点研发计划社会发展项目 BE2022697

无锡市卫生计生委精准医疗项目 jzyx02

太湖人才计划高端人才项目 2020THRC-GD-8

无锡市卫生健康委青年项目 Q202003

详细信息
    作者简介:
    通讯作者:

    许琴芬(ORCID: 0009-0004-6168-3834),主任护师,研究方向为医院感染管理,Email:840800600@126.com

  • 中图分类号: R617, R563, R619+.3

Analysis of risk factors of multidrug-resistant organism infection in lung transplant recipients based on restricted cubic spline model

More Information
  • 摘要:   目的  总结肺移植受者术后多重耐药菌(MDRO)的感染现状,分析感染相关危险因素。  方法  回顾性分析321例肺移植受者的临床资料,根据术后是否感染MDRO分为MDRO感染组(122例)和非MDRO感染组(199例)。总结肺移植受者感染MDRO情况,应用logistic回归模型分析肺移植受者感染MDRO的危险因素,结合限制性立方样条模型分析MDRO感染与呼吸机使用时间的剂量-反应关系。  结果  321例肺移植受者中,122例发生MDRO感染,感染率为38.0%。MDRO感染组检出229株病原菌,主要为革兰阴性菌(92.6%),排名前3的分别为耐碳青霉烯类鲍曼不动杆菌(46.3%)、耐碳青霉烯类铜绿假单胞菌(22.3%)和耐碳青霉烯类肺炎克雷伯菌(14.8%)。MDRO感染以下呼吸道感染为主(61.5%),其次为呼吸机相关性肺炎(26.2%)。单因素分析结果显示,采用单肺移植手术方式、术后使用体外膜肺氧合(ECMO)时间长、手术时间长、尿管插管时间长、中心静脉置管时间长、呼吸机使用时间长是肺移植受者MDRO感染的危险因素(均为P < 0.05)。多因素logistic回归分析结果显示,采用单肺移植手术方式、呼吸机使用时间长是肺移植受者MDRO感染的独立危险因素(均为P < 0.05)。限制性立方样条模型分析结果显示,使用呼吸机20 d内,随着呼吸机使用时间的增加,感染风险持续增加;20 d后,延长呼吸机使用时间不增加感染发生的风险,呈现平台效应。  结论  肺移植受者MDRO感染率呈逐年下降趋势,采用单肺移植方式、呼吸机使用时间长是肺移植受者MDRO感染的独立危险因素。

     

  • 图  1  2020年至2022年肺移植受者MDRO感染情况

    Figure  1.  Infection of MDRO in lung transplant recipients from 2020 to 2022

    图  2  肺移植受者MDRO菌株分布及构成比

    Figure  2.  Distribution and composition of MDRO strains in lung transplant recipients

    图  3  肺移植受者MDRO感染部位分布

    Figure  3.  Distribution of infection sites of MDRO in lung transplant recipients

    图  4  呼吸机使用时间与MDRO感染的剂量-反应关系

    Figure  4.  Dose-response relationship between ventilator duration and MDRO infection

    表  1  肺移植受者MDRO感染危险因素的单因素分析

    Table  1.   Univariate analysis of risk factors for MDRO infection in lung transplant recipients

    变量 MDRO感染组
    n=122)
    非MDRO感染组
    n=199)
    统计值 P
    年龄(x±s,岁) 54±12 54±14 0.324 0.754
    性别[n(%)]
      女 34(27.9) 40(20.1) 2.573 0.109
      男 88(72.1) 159(79.9)
    手术方式[n(%)]
      双肺移植 38(31.1) 97(48.7) 9.610 0.002
      单肺移植 84(68.9) 102(51.3)
    术后应用ECMO时间[MP25, P75),d] 25(12,34) 19(7,26) 3.396 0.001
    手术时间(x±s,h) 6.3±1.6 5.8±1.9 2.663 0.024
    术后抗菌药物使用时间[MP25, P75),d] 11(2,36) 7(2,35) 0.848 0.397
    尿管插管时间[MP25, P75),d] 10(6,22) 5(4,10) 5.591 < 0.001
    中心静脉置管时间[MP25, P75),d] 16(9,33) 11(6,19) 5.756 0.017
    呼吸机使用时间[MP25, P75),d] 7(2,22) 3(1,10) 5.131 < 0.001
    下载: 导出CSV

    表  2  肺移植受者MDRO感染危险因素的多因素logistic分析

    Table  2.   Multivariate logistic analysis of risk factors for MDRO infection in lung transplant recipients

    变量 β 标准误 Wald χ2 OR 95%CI P
    手术方式 0.672 0.307 2.189 1.959 1.078~3.607 0.029
    术后应用ECMO时间 0.006 0.003 1.600 1.006 0.999~1.013 0.110
    手术时间 -0.011 0.086 -0.134 0.989 0.834~1.168 0.893
    尿管插管时间 -0.007 0.008 -0.911 0.993 0.977~1.009 0.362
    中心静脉置管时间 0.002 0.005 0.448 1.002 0.993~1.011 0.654
    呼吸机使用时间 0.041 0.015 2.660 1.042 1.012~1.074 0.008
    下载: 导出CSV
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  • 收稿日期:  2023-03-21
  • 网络出版日期:  2023-07-13
  • 刊出日期:  2023-07-15

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