社区获得性耐甲氧西林金黄色葡萄球菌肺炎死亡相关危险因素分析  

Analysis of risk factors related to mortality of patients with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus

作　　者：李洪涛[1] 张天托[1] 黄静[1] 朱家馨[1] 周宇麒[1] 吴本权[1] 

机构地区：[1]中山大学附属第三医院呼吸科,广东广州510630

出　　处：《中国危重病急救医学》2010年第8期459-464,共6页Chinese Critical Care Medicine

基　　金：广东省自然科学基金资助项目（7001553）

摘　　要：目的 揭示社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）肺炎临床特征及死亡相关危险因素.方法 系统检索1995年1月至2009年12月发表的中英文文献,对比分析CA-MRSA肺炎生存和死亡者的临床特征,对相关参数进行Logistic回归分析以探讨与死亡的关系.按照是否应用抑制杀白细胞素（PVL）治疗措施分层,对患者进行Kaplan-Meier生存分析.结果 52篇文献中报道了74例病例,病死率为41.1%;从出现症状入院至死亡的平均时间为（6.1±11.0） d;58.9%的生存者平均住院时间（28.6±29.1） d.Logistic回归分析显示,流感样症状（P=0.04）、咯血（P〈0.01）、白细胞减少（P〈0.01）与死亡相关,应用抑制PVL的抗生素克林霉素或利奈唑胺与生存相关（P〈0.01）;Kaplan-Meier生存分析显示,使用抑制PVL作为分层因素具有统计学意义（χ^2=21.59,P〈0.01）.结论 流感样症状、咯血和白细胞减少是CA-MRSA肺炎死亡的相关危险因素;使用抑制PVL治疗措施可能是CA-MRSA肺炎的优选抗菌治疗方案.Objective To describe the clinical features of reported cases of community-acquired pneumonia （CAP） due to methicillin-resistant Staphylococcus aureus （MRSA）, and to evaluate the risk factors related to outcome. Methods A systematic search of databases from January 1995 to December 2009 was performed. Baseline characteristics of survivors and non-survivors in the hospital were compared with the χ^2test for categorical variables. Variables with P〈0.2 were entered in Logistic regression. Survival analysis was estimated by the Kaplan-Meier method according to use of antimicrobials inhibiting toxin production. Results Fifty-two articles were identified reporting data on 74 patients, with 41.1% of total mortality, short duration of symptom onset to death [（6.1±11.0） days], and prolonged hospital admissions [（28.6±29.1） days]. Logistic regression analysis showed that influenza like symptoms （P=0.04）, hemoptysis （P〈0.01）, leucopenia （P〈0.01） were the risk factors associated with death, and using clindamycin or linezolid which could inhibit the Panton-Valentine leukocidin （PLV, P〈0.01） was the factor associated with survival. Kaplan-Meier analysis indicated that the antibiotic therapies inhibiting toxin production were associated with improved outcome in these cases （χ^2=21.59, P〈0.01）. Conclusion CAP due to MRSA is a severe disease with significant lethality. Empiric therapy of severe CAP with flu-like symptoms, hemoptysis and leucopenia should include coverage for MRSA. Targeted treatment with antimicrobials inhibiting toxin production appear to be more appropriate selection.

关 键 词：金黄色葡萄球菌 杀白细胞素 社区获得性肺炎 生存分析 

分 类 号：R563.1[医药卫生—呼吸系统]