Objective To investigate the prevalence trend and drug resistance status of multidrug-resistant bacteria in nosocomial infection in intensive care unit (ICU) of a traditional Chinese medicine hospital in Jiangsu Province, and analyze the risk factors of prognosis of patients with nosocomial infection.
Methods The clinical data of patients with nosocomial infection in ICU of Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from January 2019 to December 2021 were retrospectively analyzed. The pathogenic spectrum and drug resistance of multidrug-resistant bacteria were analyzed. The patients with nosocomial infection were divided into survival group and death group according to the prognosis. Logistic regression was used to explore the risk factors of death in patients with nosocomial infection, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each risk factor on the death in patients with nosocomial infection in ICU.
Results A total of 242 patients were included in this study, among whom 173 (71.49%) were infected by multidrug-resistant bacteria. The majority of bacteria was Gram-negative bacteria, and showed a significant upward trend from 2019 to 2021, among which the proportion of Klebsiella pneumoniae was the highest and increased year by year, and the proportion of carbapenem-resistant Klebsiella pneumoniae was also increased year by year. Of the 242 patients, 157 (64.88%) survived and 85 (35.12%) died. The univariate analysis showed that compared with the survival group, the Acute Physiology And Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, cystatin C and serum creatinine levels in the death group were significantly increased, the prealbumin level was significantly decreased, and the proportions of patients with shock, central venous catheterization and invasive mechanical ventilation for more than 7 days were significantly increased (P < 0.05). Logistic regression analysis of risk factors showed that increased SOFA score (OR=1.146; 95%CI, 1.026 to 1.279; P=0.016), invasive mechanical ventilation for more than 7 days (OR=2.010; 95%CI, 1.049 to 3.854; P=0.035), and reduced prealbumin (OR=0.992; 95%CI=0.988 to 0.997; P=0.001) were independent risk factors for death of patients with nosocomial infection in ICU. The ROC curve showed that prealbumin and SOFA scores for predicting the death of patients with nosocomial infection in ICU were 0.646 and 0.678, respectively, and their best cut-off values were 111.5 mg/L and 6.5, respectively. The AUC of the combined test was 0.719.
Conclusion The situation of Gram-negative multidrug-resistant bacteria infection in ICU patients with nosocomial infection is serious. In the past three years, the proportion and drug resistance rate of Klebsiella pneumoniae increased year by year, and the treatment is difficult. Prolonged time of invasive mechanical ventilation, decreased prealbumin level and high SOFA score are independent risk factors for poor prognosis of patients with nosocomial infection in ICU.
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