重症颅脑损伤患者合并多重耐药菌肺部感染病原菌分布、影像学特征以及风险预测模型的建立与验证

目的 调查重症颅脑损伤患者多重耐药菌(MDRO)肺部感染病原菌分布、影像学特征并分析其危险因素,建立和验证风险预测模型。方法 回顾性收集发生肺部感染的重症颅脑损伤患者230例,按照7∶3比例原则,随机分为建模组(161例)和验证组(69例),利用建模组数据分析重症颅脑损伤MDRO肺部感染危险因素并建立风险预测模型,利用验证组数据验证模型效能。结果 230例患者中68例发生MDRO肺部感染,分离的耐药菌主要包括多重耐药鲍曼不动杆菌、多重耐药肺炎克雷伯菌、多重耐药铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌,分别占45.21%、23.29%、16.44%、15.07%。影像学表现多见胸腔积液、肺实变、磨玻璃影,分别占72.06%、63.24%、45.59%。多因素Logistic回归分析显示,年龄≥60岁(P=0.003)、糖尿病病史(P=0.021)、慢性阻塞性肺疾病病史(P=0.038)、机械通气≥7 d(P=0.001)、外院转入(P=0.008)以及昏迷(P=0.002)是建模组患者发生MDRO肺部感染的独立危险因素。利用回归方程中各指标对应的β值,四舍五入取整,建立风险评分模型,其中年龄≥60岁、糖尿病病史、慢性阻塞性肺疾病病史、机械通气≥7 d、外院转入以及昏迷风险评分对应的分值分别是1、1、1、2、2、1分,该模型在建模组和验证组中的受试者工作特征曲线下面积分别为0.845、0.809,其中≥4分为高风险人群。结论 重症颅脑损伤MDRO肺部感染病原菌以多重耐药鲍曼不动杆菌为主,影像学检查多见胸腔积液、肺实变和磨玻璃影,构建的风险评分模型在建模组和验证组均具有较高的判别效度。

Pathogen Distribution,Imaging Characteristics,and Establishment and Verification of Risk Prediction Model of Pulmonary Infection with Multi-drug Resistant Organism in Patients with Severe Craniocerebral Injury

Objective To investigate the pathogen distribution,imaging characteristics,and risk factors of pulmonary infection with multi-drug resistant organism (MDRO) in patients with severe craniocerebral injury,and establish and verify the risk prediction model. Methods A total of 230 patients with severe craniocerebral injury complicated with pulmonary infection were collected retrospectively.According to the 7∶3 ratio,they were randomly assigned into a modeling group (161 patients) and a validation group (69 patients).The risk factors of MDRO pulmonary infection were predicted with the data of the modeling group for the establishment of the risk prediction model.The data of the validation group was used to validate the performance of the model. Results Among the 230 patients,68 patients developed MDRO pulmonary infection.The isolated drug-resistant bacteria mainly included multi-drug resistant Acinetobacter baumannii,multi-drug resistant Klebsiella pneumoniae,multi-drug resistant Pseudomonas aeruginosa,and methicillin-resistant Staphylococcus aureus,which accounted for 45.21%,23.29%,16.44%,and 15.07%,respectively.The imaging characteristics included pleural effusion,lung consolidation,and ground-glass shadow,which accounted for 72.06%,63.24%,and 45.59%,respectively.Multivariate Logistic regression analysis showed that the independent risk factors for MDRO pulmonary infection included age ≥60 years (P=0.003),history of diabetes (P=0.021),history of chronic obstructive pulmonary disease (P=0.038),mechanical ventilation ≥7 d (P=0.001),transfer from other hospitals (P=0.008),and coma (P=0.002).A risk scoring model was established with the β value (rounded to the nearest integer) corresponding to each index in the regression equation.Specifically,the β values of age ≥60 years,history of diabetes,history of chronic obstructive pulmonary disease,mechanical ventilation ≥7 d,transfer from other hospitals,and coma were 1,1,1,2,2,and 1,respectively (value ≥4 indicated a high-risk population).The areas under the receiver operating characteristic curve of the modeling group and validation group were 0.845 and 0.809,respectively. Conclusions Multi-drug resistant Acinetobacter baumannii is the most common pathogen of MDRO pulmonary infection in patients with severe craniocerebral injury.Pleural effusion,lung consolidation,and ground-glass shadow were the most common imaging characteristics.The established risk model has high discriminant validity in both the modeling group and the validation group.