Clinical characteristics, risk factor analysis and peripheral blood cell changes for early warning of multidrug-resistant bacteria (MDR) infection in elderly patients

IF 3.1 4区医学 Q3 IMMUNOLOGY

Immunity, Inflammation and Disease Pub Date : 2024-07-18 DOI:10.1002/iid3.1347

Yalan Nie, Yulan Zeng

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Abstract

Objective

To explore peripheral blood indicators that may serve as early indicators for multidrug-resistant bacteria (MDR) infections in this demographic, with the goal of providing reference suggestions for the clinical prevention of MDR infections in elderly inpatients.

Methods

Clinical data of patients were divided into the MDR-infected group (n = 488) and the MDR-uninfected group (n = 233) according to the results of drug sensitivity experiments, risk factors for MDR infection, and peripheral blood indicators related to MDR infections were analyzed using univariate and multivariate logistic regression in conjunction with the construction of a Chi-squared automatic interaction detector (CHAID) decision tree model, considering statistical significance at p < .05.

Results

Of 721 patients, 488 multidrug-resistant strains were identified. Among them, with Staphylococcus spp. the most prevalent in 148 strains. The most frequent detection of MDR occurred in puncture fluid samples (167 cases). Univariate and multivariate regression analyses revealed that prolonged hospitalization, use of antibiotics preadmission, duration of antibiotics, invasive procedures or recent surgery, and coexisting lung disease were independent risk factors for contracting MDR. Subsequent analysis comparing the aforementioned influences with peripheral blood cells revealed associations between the number of antibiotic treatment days and increased neutrophil-to-lymphocyte ratio (NLR), platelet count-to-lymphocyte ratio (PLR), neutrophils, decreased lymphocytes, and increased eosinophils; preadmission antibiotic use correlated with increased PLR, NLR, neutrophils, and decreased lymphocytes; and invasive manipulation or surgery correlated with increased PLR and NLR.

Conclusions

Elevated NLR, PLR, neutrophils, lowered lymphocytes, and eosinophils may serve as early indicators of MDR infections in elderly hospitalized patients.

Abstract Image

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老年患者耐多药细菌（MDR）感染预警的临床特征、风险因素分析和外周血细胞变化。

目的探讨可作为该人群耐多药细菌（MDR）感染早期指标的外周血指标，旨在为临床预防老年住院患者MDR感染提供参考建议：根据药敏实验结果将患者的临床资料分为MDR感染组（n=488）和MDR未感染组（n=233），采用单变量和多变量Logistic回归分析MDR感染的危险因素以及与MDR感染相关的外周血指标，并结合Chi-squared自动交互检测器（CHAID）决策树模型的构建，考虑统计学意义（以p为结果）：在 721 名患者中，发现了 488 株多重耐药菌株。其中，以葡萄球菌属的 148 株最为普遍。在穿刺液样本中最常发现耐多药菌株（167 例）。单变量和多变量回归分析显示，住院时间过长、入院前使用抗生素、抗生素使用时间、侵入性操作或近期手术以及并存肺部疾病是感染 MDR 的独立风险因素。随后对上述影响因素与外周血细胞进行的比较分析表明，抗生素治疗天数与中性粒细胞与淋巴细胞比值（NLR）、血小板计数与淋巴细胞比值（PLR）、中性粒细胞、淋巴细胞减少和嗜酸性粒细胞增加有关；入院前使用抗生素与PLR、NLR、中性粒细胞和淋巴细胞减少增加有关；侵入性操作或手术与PLR和NLR增加有关：结论：NLR、PLR、中性粒细胞、淋巴细胞和嗜酸性粒细胞升高可作为老年住院患者MDR感染的早期指标。

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来源期刊

Immunity, Inflammation and Disease Medicine-Immunology and Allergy

CiteScore

3.60

自引率

0.00%

发文量

146

审稿时长

8 weeks

期刊介绍： Immunity, Inflammation and Disease is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research across the broad field of immunology. Immunity, Inflammation and Disease gives rapid consideration to papers in all areas of clinical and basic research. The journal is indexed in Medline and the Science Citation Index Expanded (part of Web of Science), among others. It welcomes original work that enhances the understanding of immunology in areas including: • cellular and molecular immunology • clinical immunology • allergy • immunochemistry • immunogenetics • immune signalling • immune development • imaging • mathematical modelling • autoimmunity • transplantation immunology • cancer immunology