确定腹腔内角膜炎的危险因素
Kelsey Habighorst1, James M Sanders1,2, Sara A Hennessy3
1Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Surgical infections
|November 27, 2023
概括
识别患有腹腔内候群 (IAC) 高风险的患者至关重要. 皮质类固醇暴露,上部胃肠道手术和机械通风是发展这种严重感染的关键风险因素.
科学领域:
- 传染性疾病 传染性疾病
- 临界护理医学 临界护理医学
- 手术感染 手术感染
背景情况:
- 腹腔内候群 (IAC) 在住院患者中存在重大挑战,导致高发病率和死亡率.
- 早期识别高风险个体对于有针对性的抗真菌治疗至关重要,有可能减少低风险患者不必要治疗的不良影响.
研究的目的:
- 确定与微生物学证实腹内角膜炎 (IAC) 的发展相关的独立风险因素.
- 帮助早期发现可能受益于及时抗真菌治疗的患者.
主要方法:
- 一项追溯的病例控制研究,涉及18岁以上的患者,已确认腹部内感染.
- 纳入标准集中在胃肠道培养物中,这些培养物对Candida spp.阳性. (病例) 或在24小时内通过手术或排水获得的细菌分离物 (对照物).
- 使用多变量回归分析来确定IAC的独立风险因素,但不包括腹腔透析患者.
主要成果:
- 多变量分析显示IAC与暴露于皮质类固醇 (OR,5.79),上胃肠道手术 (OR,3.51) 和机械通风 (OR,3.09) 之间存在显著的关联.
- 预测模型显示,接收器操作特征 (AUROC) 下的面积为0.7813.
- 对于所有已识别的风险因素 (皮质类固醇p < 0.0001,手术p = 0.017,通风p = 0.002) 观察到统计学意义.
结论:
- 暴露于皮质类固醇,接受上部胃肠道手术和需要机械通风,这些都与患有确诊的IAC的风险增加有关.
- 这些已识别的因素可以帮助临床医生分层患者,并就抗真菌治疗的必要性做出明智的决定.
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