早期正确抗菌治疗减少金黄色葡萄球菌菌血症相关性死亡

目的：探讨金黄色葡萄球菌血流感染（Stephyloccocus aureus blood stream infection,SABSI）的临床特征和死亡的危险因素，并对萁抗菌药物治疗进行评估。方法：对2009年1月-2009年12月间北京协和医院47例住院患者发生的117次SABSI进行回顾性分析。计量资料比较采用t检验或秩和检验，计数资料比较采用X^2检验或精确概率检验，预后分析采用单因素及逻辑回归分析。结果：47例SABSI患者年龄59.5±19．7岁，其中男性25例，BSI发生后24hr的APACHE ，11评分16．6±8．4分，SOFA评分7.4±5．8分。47例BSI患者中，MRSA—BSI为26例。MRSA-BSI组年龄（p=0．025）．近期侵入性操作史（p=0．006）．BSI前接受2种或2种以上抗菌药物治疗（p=0．001）、严重感染/感染性休克发生率（p=0．003），APACHE 11评分《p=0．005）、SOFA评分（p=0．005），BSI前LOS≥2周（p=0．014）、收入ICU治疗（p〈0．001）等指标均最著高于MSSA-BS1组。所有患者中，菌血症相关病死率为：42．6％（20、47）．住院病死率为：51．1％（24／47）。MRSA-BSI患者的菌血症相关病死率及住院病死率均离于MSSA—BS1缀，转别为[57．7％（15／26）vs23．8％（5／21）,p=0．020]．[65.4％《17／26）vs33.3％（7／21），p=0．029]。Logistic回归分析显示。SOFA评分（OR=1.7，95％CI：1．27-2.23，P〈0．001）．非早期正确抗菌药物治疗（OR=14．6.95％CI：1．04-205．20,p=0．047]是影响患者菌症相关性死亡的独立危险因素。仅SOFA评分（OR=2．3．95％CI：1．3-4.02，P=0．004）是影响患者住院预后的独立危险因素。结论：MRSA-BSI患者病情重，病死率离。器官功能受损的严重程度（SOFA评分）与患者预后呈正相关。早期正确抗菌药物治疗可降低菌血症相关病死率。

Adequate Antimicrobial Therapy Reduces Staphyloccocus Aureus Bacteremia Related Mortality

Objective： Analyzing the clinical characters and risk factors related mortality in staphyloccocus aureus blood stream infection （ SABSI ） patients, in order to improve their outcome. Methods： The retrospective analysis was conducted in Peking Union Medical College Hospital, 117 SABSIs happened in 47 patients in admission were involved fi＇om Jan to Dec in 2009. Results： There were 25 males in 47 patients. Mean age was 59.5~19.7 years old, APACHE II were 16.6~8.4 and SOFA score were 7.4~5.8 after SABSI in all the patients. There were 26 MRSA and 21 MSSA in 47 SABSI patients. Contrasted with MSSA group, there were more aged patients （p=0.025） , more patients received recent invasive procedures （p=0.006） and _〉2 kinds antibiotics （p=0.001） before BSI, more patients had ≥2 week stay and ever admission to ICU before BSI, higher APACHE II （p=0.005） and SOFA （p=0.005） score after BSI, more sepsis and septic shock patients after BSI in MRSA group. Bacteremia related mortality was 42.6% （20/47） and admission mortality was 51.1% （24/47） in all the patients. Contrasted with MSSA group, MRSA group had higher Bacteremia related mortality [57.7% （15/26） vs 23.8% （5/21） , p=0.020] and admission mortality[65.4% （17/26） vs 33.3% （7/21） , p=0.029]. Inadequate early antimicrobial treaunent （OR=14.6, 95%C1： 1.04-205.20, p=0.047） and SOFA score alter BSI （OR-1.7, 95%C1： 1.27-2.23, P〈0.001 ） was independent risk factor of baeteremia related mortality. Only SOFA score after BSI was independent risk factor of admission mortality. Conclusion： In SABSI, MRSA group were in more serious situation and with higher mortality. Inadequate early antimicrobial treatment was correlated with higher bacteremia related mortality.