铜绿假单胞菌败血症预后因素分析  

Prognosis of Pseudomonas aeruginosa Septicemia

作　　者：刘刚[1] 蔡绍曦[1] 耿穗娜[2] 佟万成[1] 吴雷[1] 

机构地区：[1]南方医科大学南方医院呼吸科,广东广州510515 [2]南方医科大学南方医院检验科,广东广州510515

出　　处：《中华医院感染学杂志》2010年第6期870-872,共3页Chinese Journal of Nosocomiology

基　　金：广东省重大科技计划项目(2008A060202013)

摘　　要：目的分析铜绿假单胞菌(PAE)败血症的预后因素。方法采用单因素分析、多因素Logistic回归分析、K-M法回顾性分析医院5年发生的89例PAE败血症的临床资料。结果多因素Logistic回归分析发现:高Pitt菌血症评分(OR=4.465)和不适当经验性抗菌药物治疗(OR=28.796)是患者死亡的独立预后因素;经验性抗菌药物联合治疗可以降低不适当治疗的发生,对于粒细胞缺乏患者,经验性抗菌药物联合治疗较单药治疗、确诊后抗菌药物联合治疗较单药治疗的生存时间(26.83 d/24.06 d、26.88 d/26.00 d)差异无统计学意义;对于非粒细胞缺乏患者,经验性抗菌药物联合治疗较单药治疗生存时间长(27.67 d/21.75 d,P<0.05),生存率高;确诊后抗菌药物联合治疗和单药治疗的生存时间(27.13 d/25.77 d)差异无统计学意义。结论高Pitt菌血症评分和不适当经验性抗菌药物治疗是PAE败血症死亡的独立预后因素;对于非粒细胞缺乏患者,经验性抗菌药物联合治疗较单药治疗生存时间长,生存率高。OBJECTIVE To investigate the factors related with poor prognosis for Pseudomonas aeruginosa septicemia.METHODS By a retrospective study,the data of 89 cases with P.aeruginosa septicemia from Jan 2004 to May 2009 in Nanfang Hospital were analyzed.RESULTS The multivariate Logistic regression analysis was used to identify two independent factors： high Pitt Bacteremia Score（OR=3.725） and inappropriate empiric antibiotic therapy（OR=42.334）.Empiric combination antibiotic therapy could reduce the frequency of inappropriate antibiotic therapy.Kaplan-Meier method analysis identified：compared to monotherapy,for agranulocytosis patients receiving empiric/definite combination antibiotic therapy,the difference between survival time（26.83 days/24.06 days;26.88 days/26.00 days） was not statistically significant.Compared to monotherapy,for non-agranulo cytosis patients receiving empiric combination antibiotic therapy,the survival time（27.67 days/21.75 days,P0.05） was longer and survival rate was higher with sighificant difference.Compared to monotherapy,for non-agranulocytosis patients receiving definite combination antibiotic therapy,the difference between survival time（27.13days/25.77 days） was not statistically significant.CONCLUSIONS High Pitt Bacteremia Score and inappropriate empiric antibiotic therapy are independent prognostic factors for P.aeruginosa septicemia.Compared to monotherapy,for non-agraulocytosis patients receiving empiric combination antibiotic therapy,the survival time is longer and survival rate is higher.

关 键 词：铜绿假单胞菌 败血症 预后因素 抗菌药物治疗 非粒细胞缺乏 

分 类 号：R378.991[医药卫生—病原生物学]