铜绿假单胞菌血流感染67例临床及预后危险因素分析  

Analysis of clinical characteristics and prognostic risk factors of pseudomonas aeruginosa bloodstream infection in 67 cases

作　　者：苏冬梅 赵雷 董琳 杨万春[1] SU Dongmei;ZHAO Lei;DONG Lin;YANG Wanchun(Department of Respiratory Medicine,The Second People’s Hospital in Hefei,Hefei,Anhui 230011,China)

机构地区：[1]合肥市第二人民医院呼吸与危重症医学科,安徽合肥230011

出　　处：《安徽医药》2021年第1期201-204,共4页Anhui Medical and Pharmaceutical Journal

基　　金：蚌埠医学院科研项目(BYKY2019300ZD)。

摘　　要：目的探讨院内获得性铜绿假单胞菌血流感染的临床特征并探究影响其预后的危险因素。方法收集合肥市第二人民医院2013年1月至2019年1月血培养铜绿假单胞菌阳性临床病例及相应病人的临床、微生物资料,分组比较多重耐药组(MDR)与非多重耐药组(非MDR)、死亡组与存活组的临床特征,探究其多重耐药及死亡的独立危险因素。结果共纳入67例,年龄(51±26)岁,总住院死亡率为44.8%(30/67),MDR共27例。单因素分析显示,MDR组急性生理与慢性健康状况评分(APACHEⅡ评分)、合并外科手术、TTP(血培养阳性报时间)、入住ICU、有创机械通气、感染前1个月抗生素应用≥7 d、出现败血症及休克、死亡均高于非MDR组(P<0.05)。死亡组年龄≥70岁、APACHEⅡ评分、入住ICU、有创机械通气、合并外科手术、MDR、白蛋白<30 g/L、出现败血症及休克均大于存活组(P<0.05)。进一步多因素logistic回归分析显示APACHEⅡ评分、合并外科手术是病人多重耐药及住院期间死亡的独立危险因素。白蛋白<30 g/L是病人死亡的独立危险因素,而经验性敏感抗生素治疗是降低死亡的因素。结论铜绿假单胞菌血流感染多重耐药率高,病情重,病死率高,经验性敏感抗生素治疗是病人存活的保护性因素。Objective To explore the clinical characteristics and prognostic risk factors of hospital-acquired Pseudomonas aeruginosa bloodstream infection.Methods The clinical and microbiological data of blood culture from the Pseudomonas aeruginosa-positive cases admitted to the Second People’s Hospital in Hefei from January 1,2013 to January 1,2019 were collected.Comparisons were made between dead and survival group,and multidrug-resistant vs.non-multidrug-resistant group,multidrug-resistant and prognostic risk factors were explored.Results A total of 67 patients aged(51±26)years were enrolled in this study,including 27 multidrug-resistant strains.The total in—hospital fatality rate was 44.8%(30/67).Univariate analysis showed that the acute physiology and chronic health evaluation score(APACHEⅡscore),combined with surgery,time to positivity,admission to ICU,invasive mechanical ventilation,antibiotics usage for more than 7 days a month before infection,the rate of sepsis and septic shock,mortality of the MDR group were higher than those of the non-MDR group(P<0.05).Patients in the death group were with age over 70 years old,their APACHEⅡscore,ICU stay and invasive mechanical ventilation,combined with surgery,MDR,Albumin less than or equal to 30 g/L,sepsis and shock were higher than those of the survival group(P<0.05).Multivariate Logistic regression analysis showed that APACHEⅡscore,and surgical operation were the independent risk factors for patients with multi-drug resistance and hospital mortality.Albumin less than or equal to 30 g/L was an independent risk factor for mortality during hospital stay,while the experience of susceptible antibiotic therapy was a factor in reducing fatality.Conclusion Pseudomonas aeruginosa bloodstream infection has a high rate of MDR resistance.Patients showed severe clinical status and high mortality rate.and empirical sensitive antimicrobial treatment is a protective factor.

关 键 词：铜绿假单胞菌 血流感染 多重耐药 危险因素 预后 

分 类 号：R446.5[医药卫生—诊断学]