摘要
目的探讨恶性肿瘤合并医院获得性屎肠球菌血流感染患者的临床特点及其死亡危险因素。方法回顾性收集2012年1月-2015年12月恶性肿瘤合并医院获得性屎肠球菌血流感染93例患者的临床资料,采用logistic回归分析死亡危险因素。结果 93例患者中肿瘤类型为实体肿瘤82例占88.17%;伴有发热患者86例占92.47%,伴有寒颤患者56例占60.22%;白细胞计数和(或)中性粒细胞计数升高84例占90.32%,C-反应蛋白(CRP)升高89例占95.70%;继发性血流感染61例占65.59%;药敏数据显示,对万古霉素的耐药率为5.63%,无替考拉宁和利奈唑胺耐药菌株;30天病死率为26.88%;单因素分析显示入住ICU、肾功能不全、查尔森合并指数(CCI)、急性生理慢性健康评分(APACHEⅡ)、继发血流感染、发病前30天内行外科手术、化疗、机械通气、气管插管/切开和留置尿管与死亡相关(P<0.05);多因素logistic回归分析显示仅APACHE II评分与死亡相关(P<0.001)。结论恶性肿瘤合并医院获得性屎肠球菌血流感染患者的临床特点主要有发热、寒颤、白细胞和(或)中性粒细胞升高、CRP升高;屎肠球菌分离株对万古霉素、替考拉宁和利奈唑胺均敏感;高APACHEⅡ评分是死亡的独立危险因素。
OBJECTIVE To investigated the clinical characteristics and risk factors for mortality of malignancy patients with nosocomial Enterococcus faecium bloodstream infections（BSI）.METHODS The clinical data of malignancy patients with nosocomial E.faecium BSI were collected from Jan.2012 to Dec.2015.The risk factors for mortality were analyzed by logistic regression analysis.RESULTS There were 93 malignancy patients enrolled in this study.The main tumor types were solid tumors which accounting for 82 cases（88.17%）.There were 86 cases（92.47%）of these patients with fever,56 cases（65.12%）with chill;84 cases（90.32%）with leukocytes and/or granulocytes increased,and 89 cases（95.70%）with C-reactive protein increased.Most of the patients（61 cases,65.59%）were secondary bloodstream infections.Drug sensitivity results showed,resistant rate to vancomycin was 5.63%.All these E.faeciumisolates were sensitive to both teicoplanin and linezolid.The 30-day mortality rate was as high as 26.88%.The univariate analysis showed that enrolled in ICU,renal function insufficiency,CCI score,APACHEⅡscore,secondary BSI,surgery at 30 days before the onset,chemotherapy,mechanical ventilation,tracheal intubation/tracheotomy and indwelling catheter were associated with the mortality（P 0.05）.Multivariate logistic regression analysis showed that only APACHEⅡscore was associated with the mortality（P〈0.001）.CONCLUSION The clinical features of malignancy patients with nosocomial E.faecium BSI include fever,chill,leukocytes and/or granulocytes increased,and C-reactive protein increased.These isolates are sensitive to vancomycin,teicoplanin and linezolid.For malignancy patients with nosocomial E.faecium BSI,high APACHEⅡ score is an independent risk factor for the mortality.
作者
张洋洋
杜明梅
刘运喜
吴珍
梁志欣
ZHANG Yang-yang DU Ming-mei LIU Yun-xi WU Zhen LIANG Zhi xin(Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, Chin)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第20期4618-4621,共4页
Chinese Journal of Nosocomiology
基金
军队十二五基金资助项目(BWS14J040)
关键词
屎肠球菌
医院获得性感染
血流感染
临床特征
死亡危险因素
Enterococcus faecium
Nosocomial infection
Bloodstream infections
Clinical characteristics
Mortali-ty risk factors
