复数菌与单菌血流感染患者临床特征及预后影响因素  

Clinical characteristics and impact factors of prognostic factors of patients with blood stream infection caused by multi-bacteria and mono-bacteria

作　　者：李连红[1] 成晨 饶友花[1] 李霞[1] 孙玥 宋林霞[1] 沈会红[1] 王冬梅[1] LI Lian-hong;CHENG Chen;RAO You-hua;LI Xia;SUN Yue;SONG Lin-xia;SHEN Hui-hong;WANG Dong-mei(Infection Management Office,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院感染管理办公室,江苏南京210011

出　　处：《中国感染控制杂志》2022年第9期899-904,共6页Chinese Journal of Infection Control

基　　金：江苏省中医药科技发展计划项目(YB201984)。

摘　　要：目的 调查复数菌与单菌血流感染患者的临床特征及预后的影响因素。方法 回顾性分析某三甲医院2017年1月—2021年12月临床和病原学确诊的血流感染患者的病历资料,依据检出病原菌种数分为单菌组和复数菌组,研究结局为住院期间全因死亡率。比较两组患者的临床特征及复数菌患者预后的影响因素。结果 共有430例患者血培养阳性。单菌血流感染367例(85.3%),复数菌血流感染63例(14.7%)。复数菌组患者医院感染所占比率较单菌组高(76.2%VS 56.9%),差异有统计学意义(P=0.003);复数菌组患者下呼吸道感染比率较单菌组高(44.4%VS 29.2%),差异有统计学意义(P=0.018)。复数菌组患者住院时间较单菌组高[24(16~39) VS 19(13~26)d],差异有统计学意义(P=0.002)。复数菌组患者病死率高于单菌组(12.7%VS 3.8%),且住院时间延长,差异均有统计学意义(均P<0.05)。多因素分析显示,复数菌感染(OR=3.24,95%CI:1.20~8.75)、消化道肿瘤(OR=3.28,95%CI=1.21~8.84)、有创机械通气(OR=3.40,95%CI=1.22~9.42)、深静脉置管(OR=2.76,95%CI=1.00~7.64)、留置导尿管(OR=3.28,95%CI=1.04~10.40)是血流感染患者死亡的独立危险因素。相较于单菌组,复数菌组送检时间至出院时间间隔显著延长[20(15~36)d VS 16(10~22)d,P<0.001]。单菌组与复数菌组患者检出的金黄色葡萄球菌、溶血葡萄球菌和大肠埃希菌的构成比较,差异均有统计学意义(均P<0.05)。结论 住院患者复数菌血流感染死亡风险显著增加,消化道肿瘤、有创机械通气、深静脉置管、留置导尿管是血流感染患者死亡的独立危险因素,应引起临床的重要关注。Objective To investigate the clinical characteristics and impact factors for prognosis of patents with multi-bacteria and mono-bacteria blood stream infection(BSI).Methods Medical records of patients with clinical and pathogenic diagnosis of BSI in a tertiary first-class hospital from January 2017 to December 2021 were retrospectively analyzed.According to the detected species of pathogenic bacteria,patients were divided into multi-bacteria and mono-bacteria groups,the study outcome was all-cause mortality during hospitalization.Clinical characteristics of two groups of patients and impact factors for prognosis of patients with multi-bacteria infection was compared.Results 430 patients were positive in blood culture,367 cases(85.3%) were infected by mono-bacteria and 63 cases(14.7%) were infected by multi-bacteria.Healthcare-associated infection(HAI) rate in multi-bacteria group was higher than that in mono-bacteria group(76.2% vs 56.9%,P=0.003);lower respiratory tract infection rate in patients in multi-bacteria group was higher than that in mono-bacteria group(44.4% vs 29.2%,P=0.018).Hospitalization time of patients in multi-bacteria group was higher than that in mono-bacteria group(24 [16-39] vs 19 [13-26] day,P=0.002).Death rate of patients in multi-bacteria group was higher than that in mono-bacteria group(12.7% vs 3.8%),and hospitalization time was prolonged,difference was both significant(both P<0.05).Multivariate analysis showed that independent risk factors for death in patients with BSI were multi-bacteria infection(OR=3.24,95%CI=1.20-8.75),gastrointestinal tumor(OR=3.28,95%CI=1.21-8.84),invasive mechanical ventilation(OR=3.40,95%CI=1.22-9.42),deep vein catheterization(OR=2.76,95%CI=1.00-7.64),and urinaryt ract catheterization(OR=3.28,95%CI=1.04-10.40).Compared with the mono-bacteria group,the interval between specimen submission for detection and patients’ discharge in multi-bacteria group was significantly longer(20 [15-36] vs 16 [10-22] days,P<0.001).The constituent of Staphylococcus aureus,Staphyl

关 键 词：血流感染 复数菌 单菌 预后 

分 类 号：R181.32[医药卫生—流行病学] R515.3[医药卫生—公共卫生与预防医学]