血流感染耐甲氧西林金黄色葡萄球菌对患者预后的影响

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)感染对患者住院时间、院内死亡以及不良预后的影响。方法对2009年1月1日—2013年12月31日华西医院血培养确诊为金黄色葡萄球菌感染的357例住院患者进行回顾性调查分析。结果 357例患者,MRSA感染91例,甲氧西林敏感金黄色葡萄球菌(MSSA)感染266例。MRSA组和MSSA组住院时间比较(29 d vs 23 d),差异有统计学意义(P0.01);感染前MRSA组患者住院时间长于MSSA组(P0.01),感染后两组患者住院时间比较(17 d vs 16.5 d),差异无统计学意义(P=0.92)。MRSA组和MSSA组患者死亡率比较(13.19%vs 9.02%),差异无统计学意义(χ2=1.28,P=0.26);MRSA组不良预后发生率为29.67%,高于MSSA组的16.92%(χ2=6.85,P=0.01)。多因素分析结果显示,MRSA感染是患者预后不良的独立危险因素(P0.01)。结论 MRSA感染未增加患者住院时间,但MRSA血流感染是患者不良预后的危险因素。

Impact of methicillin resistant Staphylococcus aureus bloodstream infection on the prognosis of patients

ObjectiveTo understand the impact of methicillin resistant Staphylococcus aureus (MRSA) bloodstream infection on the length of hospital stay, hospital mortality, and poor prognosis of patients.  Methods357 patients with Staphylococcus aureus (S.aureus) bacteremia  in a hospital between January 1,2009 and December 31,2013 were surveyed and analyzed retrospectively.   ResultsOf 357 patients, 91 were infected with MRSA and 266 with methicillin susceptible S.aureus (MSSA).  The length of hospital stay was statistically different between MRSA and MSSA group(29 d vs 23 d, P＜0.01）; before infection, length of hospital stay of MRSA group was longer than MSSA group（P＜0.01）; after infection, length of hospital stay was not statistically different between two groups（17 d vs 16.5 d, P=0.92）. Mortality of MRSA group and MSSA group was not statistically different（13.19％ vs 9.02％, χ2=1.28，P=0.26）. The incidence of poor prognosis of MRSA group was higher than  MSSA group(29.67％ vs 16.92％, χ2=6.85，P=0.01）. Multivariate analysis results showed that  MRSA infection was independent risk factor for poor prognosis (P＜0.01). ConclusionMRSA infection doesn’t contribute to the prolongation of hospital stay, but MRSA bloodstream infection is a risk factor for poor prognosis of patients.