摘要
目的了解危重病患者菌血症的流行病学概况和死亡的危险因素，并对抗生素治疗进行评估。方法对１９８９～１９９６年间北京协和医院加强医疗病房７５例危重病患者发生的１１６次菌血症进行回顾性分析。结果菌血症患者的病死率４３％。致病菌多为高度耐药的病原菌，如葡萄球菌（２９％）、肠球菌（１２％）、产Ｉ型诱导酶的肠杆菌（１２％）和产超广谱酶的肠杆菌（１０％）。其中革兰阳性球菌检出率较高。受累脏器按呼吸（７７％）、肝脏（５３％）、循环（５３％）、消化道（５０％）、肾脏（４７％）、中枢神经（３６％）和血液系统（２７％）依次减少。其中多器官功能衰竭为７６％。单因素分析显示原发病严重程度、多器官功能衰竭、感染性休克、肝功能衰竭、肾功能衰竭以及感染灶部位均显著影响患者的死亡（Ｐ＜０．０５）。Ｃｏｘ比例风险模型分析提示中枢神经系统功能衰竭、感染性休克、血液系统功能衰竭、肝功能衰竭和呼吸道操作均显著影响菌血症患者的生存时间。结论革兰阳性球菌是危重病患者菌血症的重要致病菌。抗生素治疗不能预防菌血症，亦不能改变菌血症患者的预后。
Objective To study the epidemiology of bacteremia of critically ill patients and the mortality associated with bacteremia and risk factors for death in an intensive care unit. Method 75 patients with 116 episodes of bacteremia were retrospectively studied. Results The mortality rate of the patients was 43%. Staphylococci (29%), Enterococci (12%), Class I inducible β lactamase producing Enterobacter (12%), extensive spectrum β lactamase producing Enterobacter (10%) were the most common pathogens, among which gram positive organisms constitute a major part. The most commonly affected organs were respiratory (77%), hepatic (53%), circulatory (53%), gastrointestinal (50%), renal (47%), central nervous (36%),and hemopoietic systems (27%). Multiple organ failure accounted for 76%. Univariate analysis revealed that the severity of underlying illness, multiple organ failure (MOF), septic shock, hepatic failure, renal failure and infection focus were the risk factors for in hospital death ( P <0.05)。Cox proportional hazard model analysis suggested central nervous system failure, septic shock, hemopoietic failure, hepatic failure and respiratory manipulation significantly affected the survival time of patients with bacteremia ( P <0.05). Conclusion Gram positive organisms are major pathogens of bacteremia in critically ill patients. Antibiotic therepy can not prevent the occurence of bacteremia, nor can it improve the prognosis.
出处
《中华医学杂志》
CAS
CSCD
北大核心
1998年第6期416-419,共4页
National Medical Journal of China
