嗜麦芽窄食单胞菌血流和尿路感染的临床特征及预后差异  

Differences in the clinical features and prognosis between Stenotrophomonas maltophilia bloodstream and urinary tract infections

作　　者：马茹 胡立芬[1] 夏玲玲[1] Ma Ru;Hu Lifen;Xia Lingling(Department of Infection,the First Afiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院感染科,合肥230022

出　　处：《国际流行病学传染病学杂志》2023年第4期264-269,共6页International Journal of Epidemiology and Infectious Disease

基　　金：高校优秀青年人才支持计划(gxyq2021172);安徽省学术和科技带头人科研活动基金(2018H194)。

摘　　要：目的了解嗜麦芽窄食单胞菌(SMA)血流和尿路感染患者的临床特征及预后差异。方法收集2020年1月至2022年10月安徽医科大学第一附属医院收治62例SMA血流感染和41例尿路感染患者的临床资料,对两组患者发生SMA感染的危险因素及预后差异进行单因素分析,并利用Logistic回归法分析SMA血流感染患者死亡的独立危险因素。结果SMA血流感染组死亡率为32.3%(20/62),SMA尿路感染组死亡率为4.9%(2/41)。尿路感染组患者合并糖尿病和肾功能不全的比例分别为24.4%(10/41)和43.9%(18/41),高于血流感染组,差异具有统计学意义(χ^(2)=5.287和8.350,P=0.021和0.004)。血流感染组患者入住重症监护室、合并脑血管疾病、气管切开、呼吸机辅助通气、留置胃管、中心静脉插管和糖肽类抗生素暴露的比例分别为80.6%(50/62)、43.5%(27/62)、38.7%(24/62)、71.0%(44/62)、82.3%(51/62)、83.9%(52/62)和41.9%(26/62),均高于尿路感染组,差异均具有统计学意义(χ^(2)=32.115、3.935、14.969、19.322、16.419、22.126、7.006,P均<0.05)。连续肾脏替代治疗(CRRT)是SMA血流感染患者死亡的独立危险因素(OR=6.863,95%CI:1.348~34.940),血培养阳性后敏感抗生素治疗与SMA血流感染患者死亡呈负相关(OR=0.100,95%CI:0.023~0.425)。结论SMA血流感染患者合并脑血管疾病、侵袭性操作的比例高于尿路感染患者。SMA血流感染死亡率高,CRRT是死亡的危险因素。ObjectiveTo understand the difference in the clinical features and prognosis between patients with bloodstream and urinary tract infection of Stenotrophomonas maltophilia(SMA).MethodsFrom January 2020 to October 2022,the clinical data of 62 patients with SMA bloodstream infection and 41 patients with SMA urinary tract infection in the First Affiliated Hospital of Anhui Medical University were collected.The risk factors and prognosis between patients with bloodstream and urinary tract infections of SMA were analyzed by univariate analysis,and then multivariate Logistic regression analysis was used to analyze the independent risk factors for mortality in patients with SMA bloodstream infection.ResultsThe mortality rates were 32.3%(20/62)and 4.9%(2/41)in the bloodstream infection group and the urinary tract infection group,respectively.The proportions of patients with diabetes and renal dysfunction in the urinary tract infection group were 24.4%(10/41)and 43.9%(18/41),respectively,which were significantly higher than those in the bloodstream infection group(χ^(2)=5.287 and 8.350,P=0.021 and 0.004).The proportions of patients with ICU occupation history,cerebrovascular disease,tracheostomy,mechanical ventilation,indwelling gastric tube,central venous catheter and glycopeptide antibiotics exposure in the bloodstream infection group were 80.6%(50/62),43.5%(27/62),38.7%(24/62),71.0%(44/62),82.3%(51/62),83.9%(52/62)and 41.9%(26/62),respectively,which were significantly higher than those in the urinary tract infection group(χ^(2)=32.115,3.935,14.969,19.322,16.419,22.126 and 7.006,all P<0.05).Continuous renal replacement therapy(CRRT)was an independent risk factor for the mortality in patients with SMA bloodstream infection(OR=6.863,95%CI:1.348-34.940),and effective antimicrobial therapy was negatively correlated with the mortality of patients with SMA bloodstream infection(OR=0.100,95%CI:0.023-0.425).ConclusionsThe proportions of patients with SMA bloodstream infection complicated with cerebrovascular disease and invasi

关 键 词：嗜麦芽窄食单胞菌 尿路感染 血流感染 临床特征 危险因素 预后 耐药性 

分 类 号：R691.3[医药卫生—泌尿科学]