神经外科脑出血患者并发多重耐药革兰阴性杆菌感染的危险因素分析

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【中图分类号】R651 【文献标识码】A

【Abstract】Objective To explore risk factors and construct a predictive model for multidrug-resistant gram-negative bacilli （MDR-GNB） infections in patients with cerebral hemorrhage. Methods A retrospective analysis was conducted on the clinical data of patients with cerebral hemorrhage complicated by gram-negative bacili infections in the department of neurosurgery at the First Affiliated Hospital of Yangtze University from December 2020 to December 2023. Patients were divided into MDR-GNB group and non-MDR-GNB group based on the occurrence of MDR-GNB infections. General characteristics，underlying diseases，treatment methods，invasive procedures，and blood cellcounts at admisson were compared between the two groups.A multivariate Logistic regression analysis was used to determine the risk factors.ResultsAtotal of 308 patients with gram-negative bacill infections were analyzed， including 143 inthe MDR group and 165 in the non-MDR group.The resultsof the univariate analysis showed that impaired consciousness，use of meropenem，duration ofantibiotics，duration of urinary catheter， duration of central venous catheter， duration of gastric tube，duration of tracheostomy， neutrophils atadmission，and systemic immune-inflammation index （SII）atadmission were significantlydierent between the two groups （P<0.05） ）. The results of the multivariate Logistic regression analysis showed that the use of meropenem，duration ofantibiotics，higher neutrophils and SIlevels at admission were the influencing factors for the MDR-GNB infections in patients with cerebral hemorrhage （P<0.05） . The results of the receiver operating characteristic curve （ROC） analysis showed that the area under the curve （AUC） of the prediction model 1 （constructed by neutrophils and duration of antibiotic use）and model 2 （constructed by SI， meropenem use and duration ofantibiotic use）for MDR-GNB infections were 0.678and 0.690，respectively.Conclusions Inaddition to use of meropenem and a longer duration of antibiotic use，the neutrophil count and SI level at admision may both be associated with the development of MDR-GNB infections in patients with cerebral hemorrhage.

【Keywords】Cerebral haemorrhage; Multidrug resistance; Gram-negative bacill; Risk factors

多重耐药菌是指对通常有效的3类或3类以上抗菌药物同时产生获得性耐药的微生物[1。（剩余12290字）