耐碳青霉烯类鲍曼不动杆菌血流感染的不同治疗策略与预后影响因素分析  

Therapeutic options and risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bloodstream infections

作　　者：何义菊 叶慧[1] 罗云婷 钟册俊[1] 李欢[1] 邓蓉[1] 吕晓菊[1] 曲俊彦[1] He Yiju;Ye Hui;Luo Yunting;Zhong Cejun;Li Huan;Deng Rong;Lyu Xiaoju;Qu Junyan(Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Infectious Diseases,People′s Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Barkam City 624000,Aba Tibetan and Qiang Autonomous Prefecture,Sichuan Province,China)

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041 [2]四川省阿坝州马尔康市阿坝藏族羌族自治州人民医院感染性疾病科,624000

出　　处：《中华传染病杂志》2020年第9期544-550,共7页Chinese Journal of Infectious Diseases

基　　金：四川省科技厅支撑计划(2017SZ0140);四川省科技厅重点研发项目(2019YFS0381);四川省科技厅软科学研究课题(2020JDR0087)。

摘　　要：目的探讨耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)血流感染患者的临床特征、治疗策略和死亡危险因素,为临床CRAB血流感染的治疗选择、预后评估提供依据。方法纳入2012年1月至2017年12月于四川大学华西医院诊断为CRAB血流感染的224例患者,根据患者自取标本日后28 d的临床转归,分成存活组和死亡组,分析其临床特征及治疗方案。计量资料比较采用t检验或Mann-Whitney U检验,计数资料比较采用χ2检验,并应用logistic回归分析CRAB血流感染患者死亡的危险因素。结果224例CRAB血流感染患者中,死亡121例(54.02%),主要分布于重症监护病房和血液科,基础疾病以急性重症胰腺炎和严重心脑血管事件多见。死亡组白细胞介素-6水平[中位数(四分位数间距)]为480.40 ng/L(1432.95 ng/L),高于存活组的107.05 ng/L(263.08 ng/L),差异有统计学意义(Z=4.526,P<0.01);死亡组和存活组的降钙素原水平[中位数(四分位数间距)]分别为3.81μg/L(17.26μg/L)和2.12μg/L(12.74μg/L),差异无统计学意义(P>0.05)。经验性使用无抗不动杆菌活性抗菌药物治疗组(单药或联合)、使用抗不动杆菌活性抗菌药物单药治疗组,以及使用至少含一种抗不动杆菌活性抗菌药物的联合治疗组的病死率分别为57.14%(64/112)、45.68%(37/81)和64.52%(20/31),差异无统计学意义(P=0.130)。肾功能损伤[比值比(odds ratio,OR)=2.181,P=0.024]、合并多器官功能障碍综合征(OR=20.376,P<0.01)是CRAB血流感染患者死亡的危险因素。结论CRAB血流感染患者病死率高,合并肾功能损伤和多器官功能障碍综合征患者的预后更差,除早期有效抗感染外,还需实施个体化综合治疗以提高疗效。Objective To analyze the clinical characteristics,therapeutic options and risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii(CRAB)bloodstream infection,and to provide evidence for clinical treatment option and prognosis evaluation of CRAB bloodstream infections.Methods A retrospective study was carried out in 224 patients with confirmed diagnosis of CRAB bloodstream infection during the period from January 2012 to December 2017 in West China Hospital,Sichuan University.The patients were divided into the death group and the survival group according to the survival status 28 days after collecting blood samples.The clinical features and therapeutic options of antibacterial drugs were reviewed.Student′s t test was used for analyzing normally distributed data and Mann-Whitney U test for non-normal data.Chi-square test was used for categorical variables.Univariate and multivariate logistic analysis were used to analyze the risk factors of mortality associated with CRAB bloodstream infection.Results Among 224 cases of CRAB bloodstream infection,121 cases died(54.02%).These patients were mainly in intensive care unit(ICU)and hematology department.The common underlying diseases were severe acute pancreatitis and severe cardiovascular events.The interleukin(IL)-6 level(median(interquartile range))in the death group(480.40 ng/L(1432.95 ng/L))was higher than that of the survival group(107.05 ng/L(263.08 ng/L)),the difference was statistically significant(Z=4.526,P<0.01).The procalcitionin(PCT)levels in the death group and the survival group were 3.81μg/L(17.26μg/L)and 2.12μg/L(12.74μg/L),respectively,with no difference between the two groups(P>0.05).The death rate of empirical treatment with a single or more non-active antimicrobial agents was 57.14%(64/112),that of monotherapy with active agent was 45.68%(37/81),and that of combination therapy with at least one active drug was 64.52%(20/31).The differences had no statistical significance(P=0.130).The logistic regression analysis sh

关 键 词：耐碳青霉烯类鲍曼不动杆菌 血流感染 治疗 危险因素 

分 类 号：R516[医药卫生—内科学]