耐甲氧西林金黄色葡萄球菌肺炎在糖尿病患者中的：一项单中心回顾性分析。
Methicillin-resistant Staphylococcus aureus pneumonia in diabetics: a single-center, retrospective analysis.
机构信息
Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
出版信息
Chin Med J (Engl). 2019 Jun 20;132(12):1429-1434. doi: 10.1097/CM9.0000000000000270.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an important issue with significant morbidity and mortality in clinical practice, especially in diabetes mellitus (DM). Studies focusing on S. aureus pneumonia in DM is limited, we sought to make a relatively comprehensive exploration of clinical characteristics, antimicrobial resistance, and risk factors for mortality of S. aureus pneumonia in DM and non-diabetics mellitus (non-DM).
METHODS
A retrospective study was conducted in Ruijin Hospital from 2014 to 2017. The characteristics of DM and non-DM patients were assessed, including demographics, comorbidities, using of invasive mechanical ventilation, Hemoglobin A1c (HbA1C), confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) score, length of hospital stay, clinical outcomes, antimicrobial susceptibility. Independent risk factors for mortality were identified by univariate and multivariate logistic regression analysis.
RESULTS
A total of 365 patients with S. aureus pneumonia were included in our study, including 144 with DM and 221 non-DM. DM patients were more susceptible to MRSA infection (65.3% vs. 56.1%, P > 0.05), suffered from much severer pneumonia with a higher CURB-65 score, invasive mechanical ventilation rate (46.5% vs. 28.1%, P < 0.01) and mortality rates (30.6% vs. 23.1%, P > 0.05); almost all DM patients had higher antimicrobial resistance than non-DM patients, the DM group had a higher co-infection rate (47.2% vs. 45.7%, P > 0.05), and Acinetobacter baumannii was the most common bacterium in DM, while Klebsiella pneumoniae ranked first in patients with non-DM. Independent risk factors for pneumonia-related mortality were MRSA and CURB-65. Higher HbA1c levels were linked to a higher MRSA infection and co-infection rate and more severe pneumonia, leading to an increase in mortality.
CONCLUSIONS
DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicrobial resistance, a higher co-infection rate, and much severer pneumonia than non-DM. MRSA itself is an independent risk factor for mortality in all patients.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）肺炎是临床实践中发病率和死亡率都很高的重要问题，尤其是在糖尿病（DM）患者中。目前关于糖尿病患者金黄色葡萄球菌肺炎的研究有限，本研究旨在对 DM 和非糖尿病（非 DM）患者金黄色葡萄球菌肺炎的临床特征、抗菌药物耐药性和死亡率的危险因素进行相对全面的探讨。
方法
本研究为回顾性研究，收集了 2014 年至 2017 年瑞金医院金黄色葡萄球菌肺炎患者的临床资料，评估了 DM 和非 DM 患者的特征，包括人口统计学、合并症、使用有创机械通气、糖化血红蛋白（HbA1C）、意识障碍、尿素、呼吸频率、血压、年龄≥65 岁（CURB-65）评分、住院时间、临床结局、抗菌药物敏感性。采用单因素和多因素 logistic 回归分析确定死亡率的独立危险因素。
结果
本研究共纳入 365 例金黄色葡萄球菌肺炎患者，其中 144 例为 DM 患者，221 例为非 DM 患者。DM 患者更易感染 MRSA（65.3%比 56.1%，P＞0.05），肺炎更严重，CURB-65 评分更高，有创机械通气率更高（46.5%比 28.1%，P＜0.01），死亡率更高（30.6%比 23.1%，P＞0.05）；几乎所有 DM 患者的抗菌药物耐药率均高于非 DM 患者，DM 组合并感染率更高（47.2%比 45.7%，P＞0.05），且鲍曼不动杆菌是 DM 患者最常见的细菌，而非 DM 患者中肺炎克雷伯菌排名第一。肺炎相关死亡率的独立危险因素是 MRSA 和 CURB-65。较高的 HbA1c 水平与更高的 MRSA 感染率和合并感染率以及更严重的肺炎相关，导致死亡率增加。
结论
血糖控制不佳的 DM 患者更易感染 MRSA。与非 DM 患者相比，他们的抗菌药物耐药性更高，合并感染率更高，肺炎更严重。MRSA 本身是所有患者死亡的独立危险因素。
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