多重耐药菌导致成人社区获得性血流感染的临床特征及危险因素  

Clinical characteristics and risk factors of community-acquired multi-drug resistant bacteria bloodstream infection in adults

作　　者：刘轶群 曹彦[1] 曹静 李林奇 谢和宾 LIU Yiqun;CAO Yan;CAO Jing;LI Linqi;XIE Hebin(Department of Emergency Medicine,Clinical Research Center For Emergency and Critical Care In Hunan Province,Hunan Provincial Institute of Emergency Medicine,Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics,Hunan Provincial People's Hospital,The First Affiliated Hospital of Hunan Normal University,Changsha 410005,China;Universtity of South China Affiliated Changsha Central Hospital,Changsha 410004,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,湖南省急危重症临床医学研究中心,湖南省急救医学研究所,急危重症代谢组学湖南省重点实验室,湖南长沙410005 [2]南华大学附属长沙市中心医院,湖南长沙410004

出　　处：《中国实验诊断学》2024年第11期1326-1331,共6页Chinese Journal of Laboratory Diagnosis

基　　金：湖南省自然科学基金(2020JJ8044,2024JJ9160)。

摘　　要：目的 探讨多重耐药菌(Multidrug-resistant organisms, MDRO)导致成人社区获得性血流感染的临床特征及危险因素,为本地区门急诊收治的社区获得性MDRO血流感染病人的治疗提供参考。方法 选取从2017年至2021年湖南省某三甲医院治疗的成人社区获得性血流感染患者共900例,根据检出菌的药敏结果将其分为MDRO组与非MDRO组。比较两组患者的临床特征及实验室指标,并分析影响成人社区获得性MDRO血流感染的相关危险因素。结果 社区获得性多重耐药菌血流感染的比例为20.78%(187/900)。单因素分析结果显示,维持性血液透析、吸烟、血液病、3个月内血流感染史、降钙素原、球蛋白、尿酸与成人社区获得性MDRO血流感染具有相关性(P<0.05)。多因素分析结果显示,维持性血液透析(OR=1.71,95%CI:1.10~2.67)、有血液病史(OR=1.85,95%CI:1.06~3.23)、降钙素原升高(OR=0.99,95%CI:0.99~1.00)是成人社区获得性MDRO血流感染的独立影响因素(P<0.05)。结论 社区获得性血流感染的病原菌中MDRO的比例较高,早期识别社区获得性MDRO血流感染患者,有利于合理使用抗菌药物、改善患者预后。Objective To explore the clinical characteristics and risk factors of community-acquired bloodstream infections in adults caused by Multidrug-resistant organisms(MDRO),so as to provide reference for the treatment of patients with community-acquired MDRO bloodstream infection treated in outpatient and emergency department in this area.Methods A total of 900 adult patients with community-acquired bloodstream infection treated in a Grade-A hospital in Hunan Province from 2017 to 2021 were divided into MDRO group and non-MDRO group based on the drug sensitivity of detected bacteria.The clinical characteristics and laboratory indicators of the two groups were compared, and the risk factors affecting adult community-acquired MDRO bloodstream infection were analyzed.Results The proportion of community acquired multidrug-resistant bacteria bloodstream infection was 20.78%(187/900).Univariate analysis showed that maintenance hemodialysis, smoking, hematopathy, history of bloodstream infection within 3 months, procalcitonin, globulin, and uric acid were correlated with community-acquired bloodstream infection in adult MDRO(P<0.05).The results of multi-factor analysis showed that Maintenance hemodialysis(OR=1.71,95%CI:1.10~2.67),history of blood(OR=1.85,95%CI:1.06~3.23),elevated procalcitonin(OR=0.99,95%CI:0.99~1.00) was an independent factor for community-acquired MDRO bloodstream infection in adults(P<0.05).Conclusion Among the pathogens of community-acquired bloodstream infection, the proportion of MDRO is relatively high.Early identification of patients with community-acquired MDRO bloodstream infection is beneficial to rational use of antibiotics and improve the prognosis of patients.

关 键 词：多重耐药菌 社区获得 血流感染 影响因素 

分 类 号：R446.1[医药卫生—诊断学]