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颅内出血(SAH)患者的多重耐药菌(MDROs)。

Multidrug-resistant organisms (MDROs) in patients with subarachnoid hemorrhage (SAH).

机构信息

Department of Neurosurgery, University Hospital, Goethe University, Frankfurt am Main, Germany.

Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany.

出版信息

Sci Rep. 2021 Apr 15;11(1):8309. doi: 10.1038/s41598-021-87863-y.

Abstract

Patient care in a neurointensive care unit (neuro-ICU) is challenging. Multidrug-resistant organisms (MDROs) are increasingly common in the routine clinical practice. We evaluated the impact of infection with MDROs on outcomes in patients with subarachnoid hemorrhage (SAH). A single-center retrospective analysis of SAH cases involving patients treated in the neuro-ICU was performed. The outcome was assessed 6 months after SAH using the modified Rankin Scale [mRS, favorable (0-2) and unfavorable (3-6)]. Data were compared by matched-pair analysis. Patient characteristics were well matched in the MDRO (n = 61) and control (n = 61) groups. In this center, one nurse was assigned to a two-bed room. If a MDRO was detected, the patient was isolated, and the nurse was assigned to the patient infected with the MDRO. In the MDRO group, 29 patients (48%) had a favorable outcome, while 25 patients (41%) in the control group had a favorable outcome; the difference was not significant (p > 0.05). Independent prognostic factors for unfavorable outcomes were worse status at admission (OR = 3.1), concomitant intracerebral hematoma (ICH) (OR = 3.7), and delayed cerebral ischemia (DCI) (OR = 6.8). Infection with MRDOs did not have a negative impact on the outcome in SAH patients. Slightly better outcomes were observed in SAH patients infected with MDROs, suggesting the benefit of individual care.

摘要

神经重症监护病房(Neuro-ICU)的患者护理具有挑战性。多药耐药菌(MDROs)在常规临床实践中越来越常见。我们评估了 MDRO 感染对蛛网膜下腔出血(SAH)患者结局的影响。对Neuro-ICU 治疗的 SAH 病例进行了单中心回顾性分析。使用改良Rankin 量表(mRS,有利(0-2)和不利(3-6))在 SAH 后 6 个月评估结局。通过配对分析比较数据。MDRO(n=61)和对照组(n=61)患者的特征在匹配组中匹配良好。在该中心,一名护士负责两个床位的病房。如果检测到 MDRO,患者将被隔离,护士将被分配到感染 MDRO 的患者。在 MDRO 组中,29 名患者(48%)结局良好,而对照组 25 名患者(41%)结局良好;差异无统计学意义(p>0.05)。不良结局的独立预后因素为入院时状态较差(OR=3.1)、伴发脑内血肿(ICH)(OR=3.7)和迟发性脑缺血(DCI)(OR=6.8)。MDRO 感染对 SAH 患者的结局没有负面影响。感染 MDRO 的 SAH 患者的结局略好,表明个体化护理有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9cb2/8050277/4ede939b5cad/41598_2021_87863_Fig1_HTML.jpg

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