医院及社区获得性金黄色葡萄球菌菌血症的流行病学和死亡率分析  

Epidemiology and death rate of healthcare-associated and community-acquired Staphylococcus aureus bacteraemia

作　　者：尚陈宇 傅锦坚 黄迪[1] 黄宪章[1] 王会敏[1] 程招敏[1] 徐建华 SHANG Chen-yu;FU Jin-jian;HUANG Di;HUANG Xian-zhang;WANG Hui-min;CHEN Zhao-min;XU Jian-hua(Second Affiliated Academy of Guangzhou University of Chinese Medicine,Guangdong Hospital of Chinese Medicine,Guangzhou,Guangdong 510120;Laboratory Department of Liitzhou Maternal and Child Health Hospital,Liiizhou,Guangxi 545001;Shunde Hospital of Guangzhou University of Chinese Medicine,Foshan,Guangdong 528333,China)

机构地区：[1]广州中医药大学第二临床医学院,广东省中医院,广东广州510120 [2]柳州市妇幼保健院检验科,广西柳州545001 [3]广州中医药大学顺德医院,广东佛山528333

出　　处：《热带医学杂志》2020年第10期1341-1344,1358,共5页Journal of Tropical Medicine

基　　金：广东省中医药局科研项目(20181102);广西壮族自治区青年科学基金(2015GXNSFBA139129)。

摘　　要：目的探讨医院相关性(HCA)和社区获得性(CA)金黄色葡萄球菌菌血症(SAB)的流行病学特征和易感因素,评估菌血症治疗结果的死亡差异。方法回顾性调查广州中医药大学第二附属医院2015年1月至2017年12月的SAB病例。以非SAB患者为对照组,对HCA-SAB和CA-SAB进行病例对照研究;比较甲氧西林敏感金黄色葡萄球菌(MSSA)和耐甲氧西林金黄色葡萄球菌(MRSA)菌血症的临床表现、相关因素和结局,通过多元Logistic回归分析SAB的死亡相关因素。结果共收集264例SAB病例。与对照组比较,CA-SAB的相关因素为住院时间长(P<0.001);HCA-SAB的相关因素为住院时间较长、3个月前有住院史、细菌感染史、入住护老院史、慢性肾衰、糖尿病病史以及入住重症监护病房(P均<0.05)。导致MRSA菌血症的独立相关因素为住院时长、糖尿病、抗生素用药史、社区获得性感染、不足够抗生素治疗。SAB 30 d死亡的相关因素为住院时长以及3个月前住院史。结论治疗住院患者的过程中,应更加重视有住院史、社区获得性感染、抗生素使用史以及糖尿病史的患者,预防其感染SAB,尽量缩短住院天数,降低因感染SAB而致死的风险。Objective To explore the epidemiological characteristics and susceptibility factors of healthcare-associated(HCA)and community-acquired(CA)Staphylococcus aureus bacteremia(SAB),and evaluate differences in mortality in bacteremia treatment outcomes.Methods All SAB cases from 2015 to 2017 in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively investigated.A case-control study of HCA-SAB and CA-SAB was conducted with non-SAB patients as control.The clinical manifestations,related factors and outcomes of methicillinsensitive Staphylococcus aureus(MSS A)and methicillin-resistant Staphylococcus aureus(MRS A)bacteremia were compared,and death related factors of SAB were explored by multiple logistic regression analysis.Results A total of 264 cases of SAB had been enrolled.Compared with the control group,the related factors of CA-SAB were long hospital stay(P<0.001).The related factors of HCA-SAB were long hospital stay,previous hospitalization 3 months,history of bacterial infection,hospitalization in nursing home,chronic renal failure,history of diabetes,and hospitalization in intensive care unit(P<0.05).The independent associated factors for MRSA bacteremia were length of hospital stay,diabetes,history of antibiotic use,community-acquired infection,and inadequate antibiotic treatment.The factors associated with 30-day death in SAB were length of hospital stay and prior hospitalization of 3 months.Conclusion During the treatment of hospitalized patients,more attention should be paid to patients with a history of hospitalization,community-acquired infection,antibiotic use and diabetes,so as to prevent their infection with SAB,shorten the length of hospitalization and reduce the risk of death due to infection with SAB.

关 键 词：医院相关性 社区获得性 金黄色葡萄球菌菌血症 相关因素 

分 类 号：R515.3[医药卫生—内科学]