急诊血流感染患者的临床特征及预后分析  

Clinical characteristics and prognosis of patients with bloodstream infection in emergency department

作　　者：刘韶瑜[1] 李姝[1] 马青变[1] 郑亚安[1] 姚贝[2] 葛洪霞[1] Liu Shaoyu;Li Shu;Ma Qingbian;Zheng Yaan;Yao Bei;Ge Hongxia(Department of Emergency Medicine,Peking University Third Hospital,Beijing 100191,China;laboratory Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,100191 [2]北京大学第三医院检验科,100191

出　　处：《中华急诊医学杂志》2020年第12期1595-1600,共6页Chinese Journal of Emergency Medicine

基　　金：北京大学医学部密西根联合项目(BMU2018JI008)。

摘　　要：目的通过急诊血流感染(bloodstream infection,BSI)患者的临床特征,分析预后的影响因素。方法本研究为单中心回顾性队列研究,纳入2018年1月1日至2018年12月31日就诊于北京某三甲医院急诊科的血流感染患者141人,分为预后良好组和预后不良组,对比两组患者的临床特征和病原学资料。多因素二元Logistic回归分析预后不良的独立危险因素。结果患者年龄中位数为69岁(四分位间距61,81),男性88人(62.4%)。所有患者中115人(81.6%)需要接受重症监护治疗,47人(33.3%)合并休克,病死率38.3%。单因素分析发现,基础疾病、特殊用药史、多部位感染、中心静脉置管、合并休克和需要重症监护治疗与患者不良预后相关。急诊BSI最常见的来源是泌尿系统(29.8%)、肝胆系统(22.0%)和下呼吸道(21.3%);菌种以大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌最多见。多因素二元Logistic回归发现,基础疾病的数量,耐药菌感染及合并休克是急诊BSI患者预后不良的独立危险因素;而泌尿系统来源的BSI预后相对良好。结论急诊BSI患者病情危重,死亡风险高,应根据患者基础疾病、感染来源、疾病严重程度、耐药菌感染风险早期启动合理抗感染治疗方案以期改善患者预后。Objective To investigate the clinical characteristics and predictors of outcomein patients with bloodstream infection(BSI)in emergency department(ED).Methods This was a retrospective cohort study on patients with BSI in ED of a tertiary hospital in Beijing in 2018.A total of 141 patients were divided into two groups,based on patient outcome on hospital discharge.Data were collected from electronic medical records including demographics of the patients and characteristics of the blood culture as well as treatment during hospital stay.Multivariable binary logistic regression was then performed to explore the predicting factors associated with unfavorable outcome.Results The median age of patients was 69 years(IQR 61-81 years)with 88 males(62.4%).There were 115(81.6%)patients received intensive care,and 47(33.3%)had septic shock.Univariate analysis revealed that comorbidities,immunosuppression treatment,multi-site infection,central vein catheterization,shock and intensive care were associated with poor prognosis.The most common sources of BSI in ED patients were urinary tract(29.8%),hepatobiliary system(22%)and lower respiratory tract(21.3%);Escherichia coli,Klebsiella pneumoniae and Staphylococcus aureus were the most common strains.Multivariate binary logistic regression showed that the number of comorbidities,shock and drug-resistant bacteria infection were independent risk factors for unfavorable prognosis in patients with BSI,while the prognosis of BSI from urinary system was relatively good.Conclusions ED physicians should optimize antibiotics according to the comorbidities,source of infection,severity of disease and risk of drug-resistant bacteria infection aiming to improve the prognosis of patients with BSI.

关 键 词：急诊 血流感染 预后 细菌耐药性 血培养 临床特征 基础疾病 感染来源 

分 类 号：R51[医药卫生—内科学]