摘要
目的探讨金黄色葡萄球菌(金葡菌)血流感染的临床特征和影响预后的危险因素,为控制细菌感染及耐药提供依据。方法回顾性分析2014年7月—2020年7月内蒙古自治区人民医院金葡菌血流感染的临床特征和预后不良的危险因素,以及细菌耐药性和调整用药与死亡率的关系。结果111例金葡菌血流感染患者中,耐甲氧西林金葡菌(MRSA)检出率37.8%(42例),甲氧西林敏感金葡菌(MSSA)检出率62.2%(69例)。MRSA组的平均年龄、住院时间、医疗费用、死亡率和预后不良率均显著高于MSSA组(P<0.05)。MRSA组的年龄≥65岁,呼吸衰竭,贫血,深静脉置管,留置导尿管,留置胃管,气管插管,入住ICU,使用碳青霉烯类、糖肽类、噁唑烷酮类、第三代头孢菌素类抗菌药物,使用抗真菌药,使用抗菌药物种类≥3种,使用激素均高于MSSA组,差异有统计学意义(P<0.05)。除了甲氧苄啶-磺胺甲噁唑(P=0.665),MRSA对大多数抗菌药物的耐药率均高于MSSA,差异具有统计学意义(P<0.05),未发现对呋喃妥因、利奈唑胺和万古霉素耐药菌株。多因素分析结果显示,呼吸衰竭和入住ICU是金葡菌血流感染预后不良的独立危险因素。调整用药组死亡率15.1%(14/93),明显低于未调整用药组55.6%(10/18),差异有统计学意义(P<0.05)。结论呼吸衰竭和入住ICU是金葡菌血流感染预后不良的独立危险因素,尤其MRSA感染易增加住院时间、医疗费用、死亡率和预后不良率,临床治疗中应合理使用抗菌药物,有效控制细菌感染和耐药的发生。
Objective To investigate the clinical characteristics and prognostic factors of Staphylococcus aureus bloodstream infection and analyze the relationship between antibiotic resistance and mortality for better infection control.Methods The clinical data of the patients with S.aureus bloodstream infection who were treated in People’s Hospital of Inner Mongolia Autonomous Region from July 2014 to July 2020 were retrospectively analyzed.Patient mortality was analyzed in terms of antibiotic resistance and antimicrobial therapy.Results Among the 111 cases of S.aureus bloodstream infection,MRSA accounted for 37.8%(42/111),MSSA accounted for 62.2%(69/111).MRSA bloodstream infections were significantly associated with old age,longer length of stay,higher medical cost,mortality,and poor prognosis than MSSA bloodstream infections(P<0.05).The patients with MRSA bloodstream infection were more likely at old age(≥65 years),associated with respiratory failure,anaemia,deep venous catheterization,indwelling urinary catheter,indwelling gastric tube,endotracheal intubation,or ICU admission,more likely received carbapenems,glycopeptides,oxazolidinones,antifungal drugs,third generation cephalosporins,multiple antibiotics(≥3)or steroids than those with MSSA bloodstream infection(P<0.05).MRSA strains showed significantly higher resistance rate to most antibiotics(P<0.05)than MSSA except trimethoprim-sulfamethoxazole(P=0.665).None of the MRSA strains was found resistant to nitrofurantoin,linezolid,or vancomycin.Multivariate analysis showed that respiratory failure and ICU admission were independent risk factors for poor prognosis of S.aureus bloodstream infection.The patients after switching therapy had a mortality rate of 15.1%(14/93),significantly lower than that of the patients without drug switching(55.6%,10/18)(P<0.05).Conclusions Respiratory failure and ICU admission are independent risk factors for poor prognosis of S.aureus bloodstream infection.MRSA infection increases the length of hospital stay,medical cost,mortality,and poor prognosis rate.Rational antimicrobial therapy is helpful for effective infection control.
作者
武杰
薛丽伟
赵建平
WU Jie;XUE Liwei;ZHAO Jianping(Inner Mongolia Clinical Medical College,Inner Mongolia Medical University,Hohhot 010010,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第3期264-270,共7页
Chinese Journal of Infection and Chemotherapy
基金
内蒙古自治区卫生计生科研计划项目(201702004)
内蒙古自治区科技计划项目(201502107)。
关键词
金黄色葡萄球菌
血流感染
临床特征
危险因素
Staphylococcus aureus
bloodstream infection
clinical characteristic
risk factor
