成人血流感染预后相关因素分析

目的了解所在医院成人血流感染后影响预后的相关因素。方法收集所在医院2002年1月至2003年12月检验科记录的血培养阳性病例131例，查阅其中91例成人患者的相关临床资料，从而了解本院血流感染病原菌种类，分析影响预后的相关因素。结果91例中革兰阴性菌53例（58．2％），主要为大肠埃希菌、沙门菌属细菌和肺炎克雷白杆菌；革兰阳性菌28例（30．8％），主要为金黄色葡萄球菌和凝固酶阴性葡萄球菌；真菌8例（8．8％），多重病原菌2例（2．2％）。本组脓毒血症患者在院病死率30．8％，铜绿假单胞菌、金黄色葡萄球菌、嗜麦芽窄食单胞菌以及大肠埃希菌产超广谱β内酰胺酶菌株感染者死亡率高达50％以上。在院病死率与病情严重程度（OR=1．15）、初始抗生素经验性治疗不合适（OR=6．77）有关。结论本研究所在医院成人血流感染病原菌以革兰阴性菌为主，病情严重以及初始抗生素经验性治疗不合适使血流感染病死率增加。

Prognostic factors for bloodstream infection in adults

Objective To investigate prognostic factors for bloodstream infection in adult patients. Methods Clinical data of 131 adult patients with positive blood cultures during January 2002 to December 2003 in the Hospital were collected and 91 cases of them were retrospectively analyzed to understand their pathogen species and prognostic factors for it.Results Blood samples from 91 patients were cultured positive,53 cases(58.2%)with gram-negative bacteria mainly including Escherichia coli,Salmonella spp. and Klebsiella pneumoniae,28(30.8%)with gram-positive bacteria,mainly including Staphylococcus aureus and coagnlase-negative Staphylococci,eight(8.8%)with fungi and two(2.2%)with multiple infections.Case fatality ratio in this group of patients with septicemia was 30.8% during their hospitalization,and that in those with Pseudomonas aeruginosa,Staphylococcus aureus,Stenotrophomonas maltophilia and E.coli with extended-spectrum beta-lactamase was over 50%.Case fatality ratio was associated with severity of sepsis(OR=1.15)and inappropriately initial empirical treatment with antibiotics (OR=6.77).Conclusions Pathogen causing bloodstream infection in adults were mainly gram-negative bacteria and severity of infection and inappropriate initial antibiotics treatment could increase their fatality.