| 胡爱玲,孙超,王娜,等.肝脓肿病原菌分布、耐药性及并发脓毒症风险预测模型的构建[J].安徽医药,2025,29(7):1399-1405. |
| 肝脓肿病原菌分布、耐药性及并发脓毒症风险预测模型的构建 |
| Distribution and drug resistance of pathogenic bacteria, and construction of a risk prediction model with sepsis for liver abscess |
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| DOI：10.3969/j.issn.1009-6469.2025.07.027 |
| 中文关键词: 肝脓肿 病原菌 脓毒症 危险因素 风险预测模型 |
| 英文关键词: Hepatic abscess Pathogenic bacteria Sepsis Risk factors Risk prediction model |
| 基金项目:秦皇岛市科学技术研究与发展计划项目( 202301A024) |
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| 摘要点击次数: 241 |
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| 中文摘要: |
| 目的了解肝脓肿病原菌分布、耐药性及临床特征；探讨影响肝脓肿发生脓毒症的危险因素，构建预测模型并验证，为肝脓肿发生脓毒症的早期诊断和防治提供参考依据。方法回顾性分析秦皇岛市第一医院 2018年 1月至 2024年 3月确诊为肝脓肿的病人临床资料，将 2018年 1月至 2022年 12月收治的病人作为模型组( n=270)2023年 1月至 2024年 3月收治的病人作为验证组( n=91)，模型组病人根据是否发生脓毒症分为脓毒症组( n=67)和非脓毒症组(，n=203)。采用 logistic回归分析发生肝脓肿脓毒症的独立危险因素，并建立肝脓肿并发脓毒症风险预测模型。再将模型应用于验证组。采用受试者操作特征曲线(ROC曲线)评估预测模型的性能。结果共收集菌株 251株，革兰阴性菌 217株占 86.5%，革兰阳性菌 12.3%。其中排前 2位的是肺炎克雷伯菌( 68.3%)和大肠埃希菌( 6.0%)。肺炎克雷伯菌对临床常用的 15种抗菌药物敏感性高达 90%以上。大肠埃希菌对头孢呋辛、头孢曲松、复方磺胺甲 ..唑、喹诺酮类敏感性均未超过 50%。相比肺炎克雷伯菌，大肠埃希菌对临床常用的 15种抗菌药物的敏感性具有显著差异，呈现多重耐药。单因素分析显示脓毒症组与非脓毒症组降钙素原［ 32.39(7.2，79)μg/L比 12.4(1.4，32)μg/L］等指标差异有统计学意义(P<0.05)；多因素 logistic回归分析显示，降钙素原、血糖 ×100/钠离子、肌酐异常升高、胸腔积液、血小板减少为肝脓肿并发脓毒症的独立危险因素( OR=1.01、1.13、22.22、2.46、2.27，均 P<0.05)。模型组 ROC曲线下面积( AUC)为 0.80［95%CI:(0.74，0.87)P<0.001］。对应的灵敏度为 68.7%，特异度为 80.3%。验证组的 AUC为 0.85［95%CI:(0.75，0.94)，P<0.001］，灵敏度为 87.0%，，特异度为 75.0%。结论细菌性肝脓肿最常见病原学是肺炎克雷伯菌，其次是大肠埃希菌，与肺炎克雷伯菌相比，大肠埃希菌肝脓肿则表现为多重耐药；基于降钙素原、血糖 ×100/钠离子、肌酐异常升高、胸腔积液、血小板减少构建的预测模型对肝脓肿并发脓毒症发生具有较好的预测价值。 |
| 英文摘要: |
| Objective To investigate the distribution, drug resistance and clinical characteristics of pathogenic bacteria in hepatic ab-scess, to explore the risk factors of hepatic abscess complicated with sepsis, to construct and verify the prediction model, and to providereference for the early diagnosis and prevention of hepatic abscess complicated with sepsis.Methods Clinical data of patients diag-nosed with liver abscess in the First Hospital of Qinhuangdao from January 2018 to March 2024 were analyzed retrospectively. Patientsadmitted from January 2018 to December 2022 were selected as the model group (n=270), while patients admitted from January 2023 to March 2024 served as the validation group (n=91). Patients in the model group were assigned into sepsis group (n=67) and non-sepsis group (n=203) according to whether sepsis occurred. Logistic regression was used to analyze the independent risk factors of hepatic ab-scess with sepsis, and the risk prediction model of hepatic abscess with sepsis was established. Then the model was applied to the vali-dation group. Receiver operating characteristic curve (ROC curve) was used to evaluate the performance of the prediction model.Re. sults A total of 251 strains were collected in the past 5 years, including 217 strains Gram-negative bacteria (86.5%) and 12.3% were Gram-positive bacteria. The top two were Klebsiella pneumoniae (68.3%) and Escherichia coli (6.0%). Klebsiella pneumoniae was more than 90% sensitive to 15 commonly used antibiotics. The sensitivity of E. coli to cefuroxime, ceftriaxone, cotrimoxazole and quinolones did not exceed 50%. Compared with Klebsiella pneumoniae, the sensitivity of Escherichia coli to 15 commonly used antibiotics was sig-nificantly different, showing multiple drug resistance. Univariate analysis showed that there were statistically significant differences inprocalcitonin [32.39 (7.2, 79) μg/L vs. 12.4 (1.4, 32) μg/L] between sepsis group and non-sepsis group (P<0.05). Multivariate logistic re-gression analysis showed that procalcitonin, blood glucose×100/sodium ions, abnormal creatinine increase, pleural effusion and throm-bocytopenia were independent risk factors for hepatic abscess complicated with sepsis (OR=1.01, 1.13, 22.22, 2.46, 2.27, all P<0.05). The area under ROC curve (AUC) of the model group was 0.80 [95%CI: (0.74, 0.87), P<0.001]. The corresponding sensitivity was 68.7% and the specificity was 80.3%. The AUC of the validation group was 0.85 [95%CI: (0.75, 0.94), P<0.001], the sensitivity was 87.0%, and the specificity was 75.0%.Conclusion The most common pathogen of bacterial liver abscess is Klebsiella pneumoniae, fol-lowed by Escherichia coli. Compared with Klebsiella pneumoniae, Escherichia coli liver abscess shows multidrug resistance. The predic-tion model based on procalcitonin, blood glucose×100/sodium ions, abnormal creatinine increase, pleural effusion and thrombocytope-nia has a good value in predicting the occurrence of hepatic abscess complicated with sepsis. |
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