肠球菌血流感染的临床特征和预后因素分析  

Clinical characteristics of bloodstream infections caused by Enterococci and prognostic factors

作　　者：陈亮[1] 李真[1] 刘颖[2] 白鹭[1] 刘佳[1] 

机构地区：[1]北京积水潭医院感染疾病科,北京100035 [2]北京积水潭医院检验科,北京100035

出　　处：《中华医院感染学杂志》2017年第9期1944-1947,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨肠球菌血流感染(BSI)的危险因素、临床特点、药物敏感性及预后因素,为临床治疗提供参考依据。方法回顾性分析2011年10月1日-2016年10月1日医院89例肠球菌BSI患者的临床资料,包括人口学情况、基础病、治疗、药敏和一般实验室检查资料;89例肠球菌BSI患者中30d死亡者32例(死亡组),余下57例患者为存活组。结果 89株肠球菌中,屎肠球菌37株,粪肠球菌52株;肠球菌BSI的易感因素:静脉置管、近期手术史、留置尿管、胃肠道感染、肺部感染;屎肠球菌和粪肠球菌对万古霉素和利奈唑胺的敏感率均为100.0%,屎肠球菌对青霉素G和氨苄西林的敏感率<14.0%,粪肠球菌对青霉素G和氨苄西林的敏感率>80.0%;肠球菌BSI 30d病死率为36.0%;单因素分析发现,存活组在年龄、合并脑血管病、冠心病、恶性肿瘤、免疫抑制治疗、慢性肾病、慢性肺病、留置导尿液、肺部感染、肝胆胰感染、血尿素、肌酐、降钙素原、低血压、无创机械通气、有创机械通气、使用血管活性药物、屎肠球菌感染方面低于死亡组;在血小板、白蛋白、氧合指数、合理抗感染治疗方面高于死亡组,两组差异有统计学意义(P<0.05);logistic回归分析发现,慢性肾病、恶性肿瘤、屎肠球菌感染是肠球菌BSI死亡的独立危险因素,而合理的抗感染治疗是保护因素。结论屎肠球菌和粪肠球菌对万古霉素和利奈唑胺仍保持着高敏感性,但屎肠球菌的耐药性要高于粪肠球菌;慢性肾病、恶性肿瘤、屎肠球菌感染是肠球菌BSI死亡的独立危险因素,合理抗感染治疗是肠球菌BSI死亡的独立保护因素。OBJECTIVE To explore the risk factors and clinical characteristics of bloodstream infection（BSI）caused by Enterococci,analyze the drug susceptibility,and observe the prognostic factors so as to provide guidance for clinical treatment.METHODS A total of 89 patients with Enterococci BSI who were treated in the hospital from Oct1,2011 to Oct 1,2016 were enrolled in the study,the clinical data,including demographic information,underlying diseases,treatment,drug susceptibility,and general laboratory examination data,were retrospectively analyzed.Among the 89 patients with Enterococci BSI,32 patients who died within 30 days were assigned as the death group,and the rest of 57 patients who survived were set as the survival group.RESULTS Of the 89 strains of Enterococci,37 were Enterococcus faecium,and 52 were Enterococcus faecalis.The predisposing factors for the Enterococci BSI included intravenous catheterization,recent history of surgery,urinary catheter indwelling,gastrointestinal tract infection,and pulmonary infection.The drug susceptibility rates of E.faecium and E.faecalis to vancomycin and linezolid were 100.0%;the drug susceptibility rate of E.faeciumto penicillin G and ampicillin was less than 14.0%;the drug susceptibility rate of E.faecalis to penicillin G and ampicillin was more than80.0%.The 30-day mortality rate of the patients with Enterococci BSI was 36.0%.The univariate analysis showed that the survival group was lower than the death group in the age,complication with cerebrovascular diseases,coronary heart disease,malignant tumor,immunosuppressive therapy,chronic nephrosis,chronic lung disease,detained urine,pulmonary infection,hepatobiliary and pancreatic infection,blood urea,creatinine,procalcitonin,hypotension,noninvasive mechanical ventilation,invasive mechanical ventilation,use of vasoactive drugs,and E.faeciuminfection;the survival group was higher than the death group in the thrombocyte,albumin,oxygenation index,and rational treatment of infection,and there was significant difference between

关 键 词：肠球菌 血流感染 临床特征 预后 

分 类 号：R378.1[医药卫生—病原生物学]