铜绿假单胞菌血流感染患者细菌耐药性及预后影响因素分析

目的探讨铜绿假单胞菌血流感染患者细菌耐药性及预后的影响因素。方法回顾性分析2016年1月-2018年12月浙江大学医学院附属第一医院137例确诊为铜绿假单胞菌血流感染患者的临床资料。单因素分析多重耐药(MDR)菌株感染相关因素。根据28 d预后分为死亡组(40例)和生存组(97例),多因素logistic回归分析死亡独立危险因素。结果纳入137例患者,28 d病死率29.2%。单因素分析显示外科手术、动静脉置管、导尿管留置、高白细胞计数、低白蛋白血症、起病时高急性生理与慢性健康(APACHEⅡ)评分与MDR菌株感染有关(P值分别为0.023、0.015、0.019、0.013、0.005、0.011)。logistic回归分析显示起病时高APACHEⅡ评分(OR=1.167,P=0.025)、低白蛋白血症(OR=0.785,P=0.004)、感染性休克(OR=5.434,P=0.036)是铜绿假单胞菌血流感染患者死亡的独立危险因素。MDR菌株血流感染患者抗菌治疗方案中,含有多黏菌素B的治疗组28 d病死率与不含多黏菌素B的治疗组28 d病死率相同,差异无统计学意义(P>0.05)。结论铜绿假单胞菌血流感染病死率高,起病时高APACHEⅡ评分、合并低白蛋白血症、感染性休克提示预后差。多黏菌素B治疗MDR铜绿假单胞菌血流感染有待大样本临床数据进一步研究。

Antibiotic resistance and prognostic factors of Pseudomonas aeruginosa bloodstream infection

Objective To investigate the antibiotic resistance and prognostic factors of P.aeruginosa bloodstream infection.Methods A retrospective analysis was conducted with the clinical data of 137 cases of P.aeruginosa bloodstream infection in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2016 to December 2018.Univariate analysis was used to identify the risk factors for multi-drug resistant bacterial infection.According to the 28-day mortality,the patients were divided into death group(40 cases)and survival group(97 cases).The independent risk factors of death were examined by multivariate logistic regression.Results A total of 137 patients were enrolled in this study.The 28-day mortality rate was 29.2%.Univariate analysis showed that surgery,arteriovenous catheterization,indwelling urinary catheter,leukocytosis,hypoalbuminemia,and high APACHE II score at onset were associated with multiple drug-resistant bacterial infections(P=0.023,0.015,0.019,0.013,0.005,0.011,respectively).Logistic regression analysis showed that high APACHE II score at onset(OR=1.167,P=0.025),hypoalbuminemia(OR=0.785,P=0.004)and septic shock(OR=5.434,P=0.036)were independent risk factors for death in patients with P.aeruginosa bloodstream infection.The 28-day mortality rate in patients with multi-drug-resistant bloodstream infections was 50.0%after polymyxin B-based antimicrobial treatment or after antimicrobial treatment without polymyxin B(P>0.05).Conclusions The mortality is high in patients with P.aeruginosa bloodstream infection.High APACHE II score,hypoalbuminemia,and septic shock at onset are associated with poor prognosis.The actual efficacy of polymyxin B in the treatment of multi-drug-resistant P.aeruginosa bloodstream infection requires further study in large sample of patients.