革兰阳性菌血流感染患者预后的影响因素分析  

Influencing factors for prognosis of patients with gram-positive bacteria bloodstream infection

作　　者：周春霞[1] 孙婧[1] 徐凤琴[1] 江山平[2] ZHOU Chun-xia;SUN Jing;XU Feng-qin;JIANG Shan-ping(Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou,Guangdong 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院医院感染管理办公室,广东广州510120 [2]中山大学孙逸仙纪念医院医院呼吸内科,广东广州510120

出　　处：《中华医院感染学杂志》2019年第1期27-31,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81670022)

摘　　要：目的探讨革兰阳性菌血流感染患者28d预后的影响因素。方法以2016年1月-2017年10月中山大学孙逸仙纪念医院革兰阳性菌血流感染患者为研究对象,回顾性分析患者临床及微生物学资料,分析其病原菌分布和临床特点,采用Cox比例风险回归分析革兰阳性菌血流感染患者28d预后的影响因素。结果研究共纳入革兰阳性菌血流感染患者276例,培养出280株革兰阳性菌。其中,凝固酶阴性葡萄球菌155株占55.36%,金黄色葡萄球菌47株占16.79%。将患者按诊断血流感染后28d的结局分为28d死亡组与28d生存组,28d死亡组患者的APACHEⅡ评分、Pitt评分、感染中毒性休克型和不适当初始抗菌药物比例高于28d生存组患者(17.125vs.11.292,3.425vs.1.699,80.000%vs.25.847%,65.000%vs.41.525%,P均<0.05)。在校正性别、年龄因素后,多因素Cox比例风险回归分析提示不适当初始抗菌药物(校正RR:3.281,95%CI:1.701-6.331,P<0.05)、感染中毒性休克型(校正RR 7.380,95%CI 3.123-17.443,P<0.05)或APACHEⅡ评分(校正RR:1.065,95%CI:1.016-1.116,P<0.05)是革兰阳性菌血流感染患者28d死亡独立危险因素。结论不适当初始抗菌药物是革兰阳性菌血流感染患者28d死亡独立危险因素。OBJECTIVE To explore the influencing factors for 28-day prognosis of the patients with gram-positive bacteria bloodstream infection.METHODS The patients with gram-positive bacteria bloodstream infection who were treated in Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University from Jan 2016 to Oct 2017 were recruited as the study objects,the clinical and microbiological data of the patients were retrospectively analyzed,the distribution of pathogens and clinical characteristics were observed,and the influencing factors for the 28-day prognosis of the patients with gram-positive bacteria bloodstream infection were analyzed by using Cox proportional hazard regression model.RESULTS A total of 280 strains of gram-positive bacteria were isolated from 276 patients with gram-positive bacteria bloodstream infection,155(55.36%)of which were coagulase-negative Staphylococcus,and 47(16.79%)were Staphylococcus aureus.The patients diagnosed with bloodstream infection were divided into the 28-day death group and the 28-day survival group according to the 28-day outcomes.The APACHEⅡ score and Pitt score of the 28-day death group were significantly higher than those of the 28-day survival group,the proportions of the patients who had septic shock and were treated with inappropriate initial antibiotics were higher in the 28-day death group than in the 28-day survival group(17.125 vs.11.292,3.425 vs.1.699,80.000% vs.25.847%,65.000% vs.41.525%,all P<0.05).After the gender and age were adjusted,the multivariate Cox proportional hazard regression analysis indicated the inappropriate initial antibiotics therapy(adjusted RR:3.281,95%CI:1.701-6.331,P<0.05),septic shock(adjusted RR 7.380,95%CI 3.123-17.443,P<0.05)and APACHEⅡscore(adjusted RR:1.065,95%CI:1.016-1.116,P<0.05)were the independent risk factors for the 28-day death of the patients with gram-positive bacteria bloodstream infection.CONCLUSION The inappropriate initial antibiotics therapy is the independent risk factor for the 28-day death of the patients with gram-positive bac

关 键 词：革兰阳性菌 血流感染 预后 不适当初始抗菌药物 

分 类 号：R378[医药卫生—病原生物学]