在重症监护室接受治疗性血交换的患者中的血液感染:为期10年的多中心研究
Sofiane Fodil1, Tomas Urbina1, Swann Bredin2
1Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
Annals of intensive care
|July 29, 2024
概括
血流感染 (BSI) 在重症监护室 (ICU) 常见,患者接受治疗性血交换 (TPE),糖尿病和更多的TPE疗程增加了风险. 这些感染导致更严重的ICU疗程和更高的死亡率.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 治疗性血交换 (TPE) 可以增加感染易感性,因为它对幽默免疫反应的影响.
- 与免疫抑制药物的联合治疗进一步提高了接受TPE的患者感染的风险.
- 了解TPE患者的血流感染 (BSI) 发生率和风险因素对于患者的安全至关重要.
研究的目的:
- 为了确定血流感染 (BSI) 在重症监护室 (ICU) 治疗治疗性血交换 (TPE) 患者的发病率.
- 为了确定与该患者群体中BSI发展相关的独立风险因素.
- 评估BSI对接受TPE的ICU患者临床结果和疾病严重性的影响.
主要方法:
- 对387名患者的回顾性分析,这些患者在2010年至2019年期间在巴黎四个重症监护室接受了至少一次TPE治疗.
- 在ICU住院期间患有BSI的患者与没有BSI的患者的比较.
- 使用多变量逻辑回归来确定BSI的独立风险因素.
主要成果:
- 总共有31名患者 (8%) 患有BSI,通常在TPE开始后7天中位发生.
- BSI的独立风险因素包括糖尿病 (OR 3.32) 和TPE会议的总数 (OR 1.14).
- 患有BSI的患者经历了更严重的ICU疗程,需要增加机械通风,脏替代疗法,血管压缩剂,并显示出更高的死亡率 (19%vs5%).
结论:
- 血流感染是接受TPE的ICU患者常见和严重的并发症.
- 糖尿病和累计较高的TPE会话数量是BSI发展的重要风险因素.
- 密切监测患者至关重要,特别是那些接受多次TPE治疗的人,以减轻感染风险和改善结果.
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