Objective  To explore risk factors and construct a predictive model for multidrug-resistant gram-negative bacilli (MDR-GNB) infections in patients with cerebral hemorrhage.

Methods  A retrospective analysis was conducted on the clinical data of patients with cerebral hemorrhage complicated by gram-negative bacilli infections in the department of neurosurgery at the First Affiliated Hospital of Yangtze University from December 2020 to December 2023. Patients were divided into MDR-GNB group and non-MDR-GNB group based on the occurrence of MDR-GNB infections. General characteristics, underlying diseases, treatment methods, invasive procedures, and blood cell counts at admission were compared between the two groups. A multivariate Logistic regression analysis was used to determine the risk factors.

Results  A total of 308 patients with gram-negative bacilli infections were analyzed, including 143 in the MDR group and 165 in the non-MDR group. The results of the univariate analysis showed that impaired consciousness, use of meropenem, duration of antibiotics, duration of urinary catheter, duration of central venous catheter, duration of gastric tube, duration of tracheostomy, neutrophils at admission, and systemic immune-inflammation index (SII) at admission were significantly different between the two groups (P<0.05). The results of the multivariate Logistic regression analysis showed that the use of meropenem, duration of antibiotics, higher neutrophils and SII levels at admission were the influencing factors for the MDR-GNB infections in patients with cerebral hemorrhage (P<0.05). The results of the receiver operating characteristic curve (ROC) analysis showed that the area under the curve (AUC) of the prediction model 1 (constructed by neutrophils and duration of antibiotic use) and model 2 (constructed by SII, meropenem use and duration of antibiotic use) for MDR-GNB infections were 0.678 and 0.690, respectively.

Conclusions  In addition to use of meropenem and a longer duration of antibiotic use, the neutrophil count and SII level at admission may both be associated with the development of MDR-GNB infections in patients with cerebral hemorrhage.

1.黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识[J]. 中国感染控制杂志, 2015, 14(1): 1-9. [Huang X, Deng ZD, Ni YX, et al. Chinese experts' consensus on prevention and control of multidrug resistance organism healthcare-associated infection[J]. Chinese Journal of Infection Control, 2015, 14(1): 1-9.] DOI: 10.3969/j.issn.1671-9638. 2015.01.001.

2.Diao H, Lu G, Zhang Y, et al. Risk factors for multidrug-resistant and extensively drug-resistant acinetobacter baumannii infection of patients admitted in intensive care unit: a systematic review and Meta-analysis[J]. J Hosp Infect, 2024, 149: 77-87. DOI: 10.1016/j.jhin.2024.04.013.

3.陈怡, 王耀武, 毕丽杰. 神经外科多重耐药菌分布及耐药性研究[J]. 中国病原生物学杂志, 2022, 17(3): 337-339. [Chen Y, Wang YW, Bi LJ, et al. Distribution and drug resistance of multidrug resistant bacteria in neurosurgery[J]. Journal of Pathogen Biology, 2022, 17(3): 337-339.] DOI: 10.13350/j.cjpb.220319.

4.Assefa M. Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns[J]. Pneumonia (Nathan), 2022, 14(1): 4. DOI: 10.1186/s41479-022-00096-z.

5.涂超超, 周权, 黄玉琴, 等. 含多黏菌素B抗菌方案治疗多重耐药革兰阴性菌HAP/VAP的贝叶斯网状Meta分析[J]. 药物流行病学杂志, 2023, 32(4): 434-445. [Tu CC, Zhou Q, Huang YQ, et al. Antibacterial regimen containing polymyxin B in the treatment of multidrug resistant gram-negative bacteria HAP/VAP: a Bayesian network Meta-analysis[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(4): 434-445.] DOI: 10.19960/j.issn.1005-0698.202304009.

6.Xue LY, Gaowa S, Wang W, et al. Ventilator-associated pneumonia in patients with cerebral hemorrhage: impact on mortality and microbiological characterization[J]. Med Clin (Barc), 2020, 154(10): 400-405. DOI: 10.1016/j.medcli.2020.01.003.

7.中华人民共和国卫生部. 医院感染诊断标准（试行）[J]. 中华医学杂志, 2001, 81(5): 314-320. DOI: 10.3760/j:issn:0376- 2491.2001.05.027.

8.刘琼兴, 陈荣琳, 路亚丽, 等. SII、NLR、PLR水平与老年脓毒症预后的相关性[J]. 医学信息, 2025, 38(6): 123-126. [Liu QX, Chen RL, Lu YL, et al. Correlation between the levels of SII, NLR, PLR and the prognosis of sepsis in the elderly[J]. Medical Information, 2025, 38(6): 123-126.] DOI: 10.3969/j.issn.1006-1959.2025.06.021.

9.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S]. Wayne, PA: CLSI, 2020: M100-S30.

10.Sania N, Saharman YR, Lestari DC, et al. Risk factors associated with the colonization of multidrug-resistant gram-negative bacteria upon admission to the intensive care unit: a cross-sectional study[J]. Acta Med Indones, 2024, 56(3): 330-340. https://pubmed.ncbi.nlm.nih.gov/39463102/.

11.Aldarhami A, Punjabi AA, Bazaid AS, et al. Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients[J]. Medicine (Baltimore), 2024, 103(10): e37389. DOI: 10.1097/MD.0000000000037389.

12.Abdel Hadi H, Dargham SR, Eltayeb F, et al. Epidemiology, clinical, and microbiological characteristics of multidrug-resistant gram-negative bacteremia in Qatar[J]. Antibiotics (Basel), 2024, 13(4): 320. DOI: 10.3390/antibiotics13040320.

13.Maina JW, Mutua JM, Musyoki AM. Carbapenem-resistant gram-negative bacterial infections and risk factors for acquisition in a Kenyan intensive care unit[J]. BMC Infect Dis, 2024, 24(1): 522. DOI: 10.1186/s12879-024-09256-6.

14.Zhang X, Wang Y, Li S, et al. Simulated drug disposition in critically ill patients to evaluate effective PK/PD targets for combating Pseudomonas aeruginosa resistance to meropenem[J].Antimicrob Agents Chemother, 2024, 68(3): e0154123. DOI: 10.1128/aac.01541-23.

15.罗艳, 宋沧桑, 王波, 等. 亚抑菌浓度美罗培南对多重耐药鲍曼不动杆菌生物膜作用的研究[J]. 中国药物评价, 2024, 41(3): 217-221. [Luo Y, Song CS, Wang B, et al. Study on the effect of meropenem at subinhibitory concentration for the biofilm of multi-drug resistant Acinetobacter Baumannii[J]. Chinese Journal of Drug Evaluation, 2024, 41(3): 217-221.] DOI: 10.3969/j.issn.2095-3593.2024.03.008.

16.廖佳馨, 胡韦维. 群体感应系统信号分子受体abaR基因对鲍曼不动杆菌致病性和获得性耐药的影响[J/OL]. 重庆医科大学学报, 50(1): 52-57. [2025-01-13]. [Liao JX, Hu WW. Effect of the quorum sensing system LuxR type regulator abaR on the pathogenicity and drug resistance of Acinetobacter baumannii[J/OL]. Journal of Chongqing Medical University, 50(1): 52-57. [2025-01-13].] DOI: 10.13406/j.cnki.cyxb.003634.

17.Qiu Z, Yuan K, Cao H, et al. Cross-talk of MLST and transcriptome unveiling antibiotic resistance mechanism of carbapenem resistance Acinetobacter baumannii clinical strains isolated in Guiyang, China[J]. Front Microbiol, 2024, 15: 1394775. DOI: 10.3389/fmicb.2024.1394775.

18.汪宗林, 陈建荣, 尤忠毓, 等. 金黄色葡萄球菌生物被膜形成与耐药机制的研究进展[J]. 生物工程学报, 2024, 40(7): 2038-2051. [Wang ZL, Chen JR, You ZY, et al. Advances in mechanisms of biofilm formation and drug resistance of Staphylococcus aureus[J]. Journal Of Biological Engineering, 2024, 40(7): 2038-2051.] DOI: 10.13345/j.cjb.230803.

19.贺丽莎, 杨灼, 冉蕾, 等. 噬菌体防治细菌生物被膜相关感染的研究进展[J]. 微生物学报, 2024, 64(10): 36703684. [He LS, Yang Z, Ran L, et al. Research progress of phages in prevention and treatment of bacterial biofilm-associated infections[J]. Acta Microbiologica Sinica, 2024, 64(10): 36703684.] DOI: 10.13343/j.cnki.wsxb.20240259.

20.李虎良, 张蕾. 抗菌药物耐药性的分子机制及抑菌策略[J]. 中国生物化学与分子生物学报, 2024, 40(6): 759-769. [Li HL, Zhang L. Molecular mechanisms and antibacterial strategies of antibiotic resistance[J]. Chinese Journal of Biochemistry and Molecular Biology, 2024, 40(6): 759-769.] DOI: 10.13865/j.cnki.cjbmb.2024.01.1365.

21.谢建平, 黄煜, 宋洁. 抗生素耐药机制与新抗感染措施研发 [J]. 四川师范大学学报（自然科学版）, 2023, 46(6): 719-730. [Xie JP, Huang Y, Song J et al. M echanism of antibiotic resistance and development of  new anti-infection measures[J]. Journal of Sichuan University (Natural Science Edition), 2023, 46(6): 719-730.] DOI: 10.3969/j.issn.1001-8395.2023.06.002.

22.皮锐, 李德辉. 转录调控因子介导细菌耐药性和耐受性的研究进展[J]. 中南医学科学杂志, 2023, 51(4): 618-621. [Pi R, Li DH. Advances in transcription factor-mediated antibiotic resistance and tolerance in bacteria[J]. Medical Science Journal of Central South China, 2023, 51(4): 618-621.] DOI: 10.15972/j.cnki.43-1509/r.2023.04.037.

23.Xie RJ, Liu XZ, Wu HY, et al. Associations between systemic immune-inflammation index and abdominal aortic calcification: results of a nationwide survey[J]. Nutr Metab Cardiovasc, 2023, 33(7): 1437-1443. DOI: 10.1016/j.numecd.2023.04.015.

24.朱敏, 黄从刚, 罗志华, 等. SII及NLR、RDW、PLR水平与脑出血后肺部感染及预后的关系[J]. 中华医院感染学杂志, 2024, 34(16): 2462-2466. [Zhu M, Huang CG, Luo ZH, et al. Correlation of levels of SII, NLR, RDW and PLR with pulmonary infection and prognosis after cerebral hemorrhage[J]. Chinese Journal of Nosocomiology, 2024, 34(16): 2462-2466.]DOI: 10.11816/cn.ni.2024-231582.

25.王万洲, 田聪, 郭力, 等. SII、NLR对颅骨修补术后手术部位感染的预测意义[J]. 徐州医科大学学报, 2023, 43(1): 33-38. [Wang WZ, Tian C, Guo L, et al. Significance of SII and NLR in predicting surgical site infection after cranioplasty[J]. Acta Academiae Medicinae Xuzhou, 2023, 43(1): 33-38.] DOI: 10.3969/j.issn.2096-3882.2023.01.006.