成人2型糖尿病患者社区发生血流感染的危险因素和病原菌特征

董琳; 王德斌; 雷祖宝; 赵雷; 许萍; 杨万春

doi:10.16462/j.cnki.zhjbkz.2020.11.012

成人2型糖尿病患者社区发生血流感染的危险因素和病原菌特征

doi: 10.16462/j.cnki.zhjbkz.2020.11.012

董琳¹,
王德斌²,
雷祖宝¹,
赵雷¹,
许萍¹,
杨万春^1, ,

1.
230011 合肥，合肥市第二人民医院呼吸与危重症医学科
2.
230011 合肥，安徽医科大学卫生管理学院卫生信息系

基金项目:

国家自然科学基金项目 81861138049

安徽医科大学科研基金 2019xkj085

详细信息

通讯作者:
杨万春，E-mail：1225399339@qq.com

中图分类号: R587.1
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出版历程
- 收稿日期: 2020-05-08
- 修回日期: 2020-07-14
- 刊出日期: 2020-11-10

Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection

1.
Department of Respiratory and Critical Diseases, the Second People's Hospital of Hefei, Hefei 230011, China
2.
Department of Health Information, School of Health Management, Anhui Medical University, Hefei 230011, China

Funds:

National Natural Science Foundation of China 81861138049

Research Fund of Anhui Medical University 2019xkj085

More Information

Corresponding author: YANG Wan-chun, E-mail:1225399339@qq.com

摘要

摘要: 目的研究成人2型糖尿病(T2DM)患者社区发生血流感染(COBSI)的危险因素和病原菌特征，为早期诊治提供理论依据。方法回顾分析合肥市第二人民医院2017年1月―2020年3月成人社区发生感染的T2DM住院患者293例，根据48 h内血培养结果分为血流感染(BSI)组和对照组，分析危险因素，构建预测模型，检验模型。分析社区获得性血流感染(CABSI)和医疗健康相关性血流感染(HCABSI)组间的病原菌特点。结果构建预测模型P=1/(1+e^-y)，y=-45.137+0.751×院外或入院48 h内体温峰值+0.033×中性粒细胞百分比+0.027×血浆渗透压+0.009×血C反应蛋白+1.144×肾功能衰竭+1.740×糖尿病酮症酸中毒(DKA)，模型曲线下面积(AUC)为0.800，95% CI为(0.747~0.853)，最佳截断值为0.208，灵敏度为0.90，特异度为0.56。对模型的校准度予以Hosmer-lemeshow检验，χ²=12.285，P=0.139。CABSI和HCABSI组间在革兰阴性菌(G^-)、大肠埃希菌、产超广谱β-内酰胺酶大肠埃希菌、革兰阳性菌(G⁺)和金黄色葡萄球菌的检出差异均具有统计学意义(均有P < 0.05)。结论院外或入院48 h内体温峰值、中性粒细胞百分比、血浆渗透压、血C反应蛋白、肾功能衰竭、DKA是成人T2DM患者COBSI的危险因素。预测模型具有较高的灵敏度，CABSI和HCABSI组间病原菌存在差异，对早期诊治具有临床指导意义。
- 2型糖尿病 /
- 血流感染 /
- 危险因素 /
- 病原菌 /
Abstract: Objective To analyze the risk factors and pathogen characteristics of adult type 2 diabetes mellitus (T2DM) patients with community-onset bloodstream infection (COBSI) risk, so as to provide theoretical basis for early diagnosis and treatment. Methods A total of 293 T2DM inpatients who were admitted to the Second People's Hospital of Hefei from the adult community during 2017/01-2020/03 were retrospectively analyzed, which were divided into bloodstream infection (BSI) group and control group according to the blood results within 48 hours. Based on the analysis of the risk factors, prediction model and test model were constructed. The characteristics of pathogenic bacteria was analyzed on community acquired bloodstream infection (CABSI) group and health care-associated community acquired bloodstream infection (HCABSI) group. Results The prediction model was established. P=1/(1+e^-y), y=-45.137+0.751×peak body temperature outside the hospital or within 48 h of admission+0.033×neutrophil percentage+0.027×plasma osmotic pressure+0.009×blood C-reactive protein+1.144×kidney failure+1.740×diabetic ketoacidosis. The area under a curve (AUC) of the model was 0.800, 95% CI was from 0.747 to 0.853, and the optimal cutoff value was 0.208 and the sensitivity was 0.90, specificity was 0.56. Hosmer-lemeshow test was performed for the calibration degree of the model, χ²=12.285, P=0.139. There were statistically significant differences (all P < 0.05) between CABSI and HCABSI groups in Gram-negative bacteria (G^-), extended-spectrum β-lactamases-producing Escherichia coli, Escherichia coli, Gram-positive bacteria (G⁺) and Staphylococcus aureus. Conclusions Peak body temperature outside the hospital or within 48 hours of admission, neutrophil percentage, plasma osmotic pressure, serum C-reactive protein, kidney failure, and diabetic ketoacidosis are risk factors for COBSI in adult T2DM patients. The prediction model has good sensitivity, and there are differences in pathogenic bacteria between CABSI and HCABSI groups, which has clinical guiding significance for early diagnosis and treatment.
- Diabetes /
- Type 2 /
- Bloodstream infection /
- Risk factors /
- Pathogenic bacteria

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图 1 2017年1月―2020年3月合肥市第二人民医院成人2型糖尿病患者社区发生血流感染联合预测模型ROC曲线图

Figure 1. The ROC curve of the combined prediction model of community-onset acquired bloodstream infection in adult type 2 diabetes mellitus patients in the Second People's Hospital of Hefei from 2017/01 to 2020/03

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表 1 2017年1月―2020年3月合肥市第二人民医院成人2型糖尿病患者社区发生血流感染临床资料比较[M(P₂₅，P₇₅)/n(%)]

Table 1. Comparison of clinical data of community-onset acquired bloodstream infection in adult type 2 diabetes mellitus patients in the Second People's Hospital of Hefei from 2017/01 to 2020/03 [M(P₂₅, P₇₅)/n(%)]

项目	BSI组(n=95)	对照组(n=198)	χ²/Z值	P值
年龄(岁)	69.0(60.0, 76.3)	70.0(62.0, 77.0)	-0.799	0.424
性别			2.503	0.114
男	41(43.2)	105(53.0)
女	54(56.8)	93(47.0)
院外或入院48 h内体温峰值(℃)	39.2(38.6, 39.6)	38.9(38.5, 39.2)	-3.378	0.001
HR(次/分)	95(84, 110)	96(85, 106)	-0.099	0.921
MAP(mmHg)	96.67(84.00, 107.33)	97.5(88.33, 106.00)	-0.820	0.412
医疗护理相关	42(44.2)	77(38.9)	0.754	0.385
COPD	5(5.3)	7(3.5)	0.147	0.701
血管疾病	49(51.6)	110(55.6)	0.409	0.522
高血压	54(56.8)	123(62.1)	0.748	0.387
肾功能衰竭	32(33.7)	24(12.1)	19.308	< 0.001
恶性肿瘤	9(9.5)	11(5.6)	1.550	0.213
皮肤黏膜屏障破坏	26(27.4)	23(11.6)	11.438	0.001
血液透析	19(20.0)	17(8.6)	7.761	0.005
DKA	8(8.4)	3(1.5)	6.670	0.010
抗生素暴露	5(5.3)	8(4.0)	0.030	0.863
糖皮质激素和(或)免疫抑制药物	5(5.3)	3(1.5)	2.131	0.144
WBC(×10⁹/L)	10.83(7.92, 13.86)	10.91(7.30, 14.37)	-0.606	0.544
NEU(×10⁹/L)	9.35(6.58, 12.49)	8.86(5.77, 12.67)	-1.348	0.178
LYM(×10⁹/L)	0.69(0.49, 0.98)	0.90(0.62, 1.32)	-4.142	< 0.001
NEU%	88.70(84.40, 91.70)	84.90(78.03, 88.92)	-4.818	< 0.001
NLR	13.98(10.27, 20.40)	10.18(5.92, 15.80)	-4.158	< 0.001
PLT(×10⁹/L)	138.5(98.0, 184.0)	151.0(119.0, 197.0)	-1.810	0.070
PLR	0.063(0.045, 0.100)	0.055(0.038, 0.086)	-2.422	0.015
ALB(g/L)	34.80(30.13, 39.63)	37.60(34.20, 40.50)	-3.505	< 0.001
PA(mg/L)	104.90(57.68, 171.28)	122.95(90.95, 157.20)	-1.756	0.079
FBG(mmol/L)	10.40(7.12, 13.11)	8.69(6.58, 11.41)	-2.506	0.012
Na(mmol/L)	136.00(133.00, 139.00)	136.50(133.00, 141.00)	-0.725	0.468
Cr(μmol/L)	93.00(64.60, 286.60)	80.00(60.78, 105.33)	-2.400	0.016
血CRP(mg/L)	32.66(17.68, 133.80)	15.46(6.35, 26.88)	-5.639	< 0.001
血浆渗透压(mOsm/L)	303.55(294.96, 310.26)	300.64(291.19, 306.76)	-2.255	0.024
HbA1c(%)	8.50(7.00, 10.70)	7.80(6.80, 9.60)	-1.803	0.071
注：HR：心率，MAP：平均动脉压，COPD：慢性阻塞性肺疾病，DKA：糖尿病酮症酸中毒，WBC：白细胞计数，NEU：中性粒细胞计数，LYM：淋巴细胞计数，NEU%：中性粒细胞百分比，NLR：中性粒细胞-淋巴细胞比值，PLT：血小板，PLR：血小板-淋巴细胞比值，ALB：白蛋白，PA：前蛋白，FBG：空腹血糖，Na：钠，Cr：肌酐，CRPC：反应蛋白，HbA1c：糖化血红蛋白。

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表 2 2017年1月―2020年3月合肥市第二人民医院成人2型糖尿病患者社区发生血流感染的多因素Logistic回归分析

Table 2. Multivariate Logistic regression analysis of risk factors for community-onset acquired blood stream infection in adult type 2 diabetes mellitus patients in the Second People's Hospital of Hefei from 2017/01 to 2020/03

因素	β	s_x	Waldχ²值	P值	OR(95% CI)值
院外或入院48h内体温峰值(℃)	0.751	0.237	10.027	0.002	2.119(1.331~3.372)
Neut%(%)	0.033	0.015	4.655	0.031	1.034(1.003~1.066)
血浆渗透压(mOsm/L)	0.027	0.013	4.467	0.035	1.027(1.002~1.053)
血CRP(mg/L)	0.009	0.002	15.932	< 0.001	1.009(1.005~1.014)
肾功能衰竭	1.144	0.365	9.835	0.002	3.141(1.536~6.422)
DKA	1.740	0.790	4.849	0.028	5.697(1.211~26.802)
常量	-45.137	10.706	17.774	< 0.001

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表 3 2017年1月―2020年3月合肥市第二人民医院成人2型糖尿病患者社区发生血流感染的病原学特点[n(%)]

Table 3. Pathogenic characteristics of community-onset acquired bloodstream infection in adult type 2 diabetes mellitus patients in the Second People's Hospital of Hefei from 2017/01 to 2020/03 [n(%)]

致病菌	CABSI组(n=53)	HCABSI组(n=45)	χ²/Z值	P值
革兰阴性菌	44(83.0)	21(46.7)	14.400	< 0.001
大肠埃希菌	31(58.5)	7(15.6)	18.897	< 0.001
肺炎克雷伯菌	9(17.0)	10(22.2)	0.428	0.513
产气肠杆菌	2(3.8)	0(0.0)	-	0.498
粘质沙雷菌	1(1.9)	0(0.0)	< 0.001	1.000
变形杆菌属	0(0.0)	1(2.2)	-	0.459
弗劳地柠檬酸杆菌	0(0.0)	2(4.4)	-	0.208
脆弱拟杆菌	1(1.9)	1(2.2)	-	1.000
革兰阳性菌	8(15.1)	22(48.9)	13.085	< 0.001
金黄色葡萄球菌	0(0.0)	11(24.4)	14.594	< 0.001
表皮葡萄球菌	2(3.8)	4(8.9)	0.397	0.529
其他凝固酶阴性葡萄球菌	4(7.5)	3(6.7)	< 0.001	1.000
肺炎链球菌	1(1.9)	0(0.0)	-	1.000
其他链球菌	1(1.9)	1(2.2)	-	1.000
肠球菌	0(0.0)	3(6.7)	1.745	0.187
真菌	1(1.9)	2(4.4)	0.021	0.885
白假丝酵母菌	1(1.9)	2(4.4)	0.021	0.885
耐药菌	10(18.9)	6(13.3)	0.546	0.460
产ESBLs大肠埃希菌	9(17.0)	1(2.2)	4.287	0.038
产ESBLs肺炎克雷伯菌	0(0.0)	1(2.2)	-	0.459
CRKP	0(0.0)	1(2.2)	-	0.459
MRSA	0(0.0)	2(4.4)	-	0.208
MRCNS	1(1.9)	1(2.2)	-	1.000
注：ESBLs超广谱β-内酰胺酶、CRKP耐碳青酶烯类肺炎克雷伯菌，MRSA耐甲氧西林金黄色葡萄球菌，MRCNS耐甲氧西林的凝固酶阴性葡萄球菌。

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