Tian B S, Ling Y, Lyu J W, Ye L, Gu B
Medical Technology School of Xuzhou Medical University, Xuzhou Key Laboratory of Laboratory Diagnostics, Xuzhou 221004, China Division of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences,Guangzhou 510080, China.
Division of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences,Guangzhou 510080, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2023 Feb 6;57(2):241-246. doi: 10.3760/cma.j.cn112150-20220221-00161.
To understand the clinical characteristics of bloodstream infection and the main risk factors affecting clinical prognosis, providing a reference for clinical prevention and control of bloodstream infection. In this study, the clinical data of 152 patients with bloodstream infection admitted to Guangdong Provincial People's Hospital from January 2019 to December 2021 were retrospectively analyzed by reviewing the electronic medical record system, including underlying diseases, clinical characteristics, risk factors, and bacterial resistance. Statistical methods such as Chi-Squared Test and Test were used to analyze the related risk factors that may affect the clinical characteristics and prognosis of patients with and methicillin-resistant (MRSA) bloodstream infection, then the variables with <0.05 in univariate analysis were included in the multivariate logistic regression model to analyze the independent risk factors of poor prognosis. The results showed among 152 patients with bloodstream infection, 50 patients (32.89%) were infected with MRSA. In comparison, 102 patients (67.11%) were infected with methicillin-sensitive (MSSA). Except for rifampicin, the resistance rate of MRSA to commonly used antibiotics was all higher than that of MSSA, and the difference was statistically significant (Chi-square values were 8.272, 11.972, 4.998, 4.776, respectively;all values are less than 0.05). Strains resistant to vancomycin, linezolid, and quinupristin/dalfopristin were not found. In the MRSA group, indwelling catheter and drainage tube, carbapenems, and β-lactamase inhibitor treatment were significantly higher than the MSSA group. The difference was statistically significant (<0.05). The incidence of poor prognosis of bloodstream infection in the MRSA group was higher than that in the MSSA group (34.00% 13.73%), and the difference was statistically significant (=8.495, <0.05). No independent risk factors associated with poor prognosis were found in the included patients with MRSA bloodstream infection.Multivariate Logistic regression model analysis showed that solid malignant tumors (=13.576, 95%: 3.352-54.977, <0.05), mechanical ventilation (=7.468, 95%: 1.398-39.884, <0.05) were the most important independent risk factors for poor prognosis in patients with bloodstream infection. In summary, the poor prognosis rate of MRSA bloodstream infection is higher than that of MSSA. The clinical evaluation of related risk factors should be strengthened, targeted prevention and control interventions should be taken to improve the prognosis of patients with bloodstream infection, and the use of antibiotics should be rational and standardized, to control bacterial infection and drug resistance effectively
为了解血流感染的临床特征及影响临床预后的主要危险因素,为临床预防和控制血流感染提供参考。本研究通过回顾电子病历系统,对2019年1月至2021年12月在广东省人民医院收治的152例血流感染患者的临床资料进行回顾性分析,包括基础疾病、临床特征、危险因素及细菌耐药情况。采用卡方检验等统计方法分析可能影响甲氧西林敏感金黄色葡萄球菌(MSSA)和耐甲氧西林金黄色葡萄球菌(MRSA)血流感染患者临床特征及预后的相关危险因素,将单因素分析中P<0.05的变量纳入多因素logistic回归模型分析预后不良的独立危险因素。结果显示,152例血流感染患者中,50例(32.89%)为MRSA感染,102例(67.11%)为MSSA感染。除利福平外,MRSA对常用抗生素的耐药率均高于MSSA,差异有统计学意义(卡方值分别为8.272、11.972、4.998、4.776;均P值<0.05)。未发现对万古霉素、利奈唑胺和奎奴普丁/达福普汀耐药的菌株。MRSA组中,留置导管和引流管、碳青霉烯类及β-内酰胺酶抑制剂治疗的比例显著高于MSSA组,差异有统计学意义(P<0.05)。MRSA组血流感染预后不良的发生率高于MSSA组(34.00%比13.73%),差异有统计学意义(χ²=8.495,P<0.05)。纳入的MRSA血流感染患者中未发现与预后不良相关的独立危险因素。多因素logistic回归模型分析显示,实体恶性肿瘤(χ²=13.576,95%CI:3.352-54.977,P<0.05)、机械通气(χ²=7.468,95%CI:1.398-39.884,P<0.05)是血流感染患者预后不良的最重要独立危险因素。综上所述,MRSA血流感染的预后不良率高于MSSA。应加强对相关危险因素的临床评估,采取针对性的防控干预措施以改善血流感染患者的预后,合理规范使用抗生素,有效控制细菌感染及耐药。