皮肌炎患者合并感染307例回顾性研究

Infection in patients with dermatomyositis:a retrospective study of 307 cases

目的了解皮肌炎住院患者的感染情况,探讨皮肌炎患者发生感染的相关危险因素。方法回顾性分析2002年5月—2007年7月在复旦大学附属华山医院确诊为皮肌炎的307例住院患者的感染发生情况及对病原菌的耐药情况;选择皮肌炎患者感染发生的可疑危险因素,先通过χ2检验进行单因素分析,然后对差异有统计学意义的因素运用Logistic回归分析进行多因素分析。结果307例皮肌炎患者中,发生感染108例,感染发生率为35.2%。17例死亡患者均合并呼吸道感染。常见的感染部位依次为呼吸道(76.9%)、尿路(13.9%)、口腔(13.0%)及皮肤软组织(7.4%)。在感染病原体构成中,以革兰阴性菌为主。最常见的菌株为克雷伯菌属(13.5%)、不动杆菌属(6.2%)、金黄色葡萄球菌(10.4%)及白念珠菌(33.3%)。细菌药敏试验结果显示,耐药菌株中产超广谱β内酰胺酶(ESBL)菌株7株(38.9%),耐甲氧西林葡萄球菌(MRSA)5株(42.1%)。革兰阴性菌对头孢哌酮/舒巴坦及碳青霉烯类药物的敏感率较高。≥60岁(β=0.697)、肺间质病变(β=1.466)、吞咽困难(β=0.737)及大剂量激素治疗(累积激素用量≥1g,β=0.700)为皮肌炎患者感染发生的独立危险因素(P值均<0.05)。结论对存在上述感染相关危险因素的患者,应密切监测有无感染的发生。呼吸道为皮肌炎患者最常见的感染部位,预后较差;病原菌以革兰阴性菌多见,可选用头孢他啶、头孢哌酮/舒巴坦或碳青霉烯类药物作为经验性抗感染治疗。

Objective To investigate the infections in patients with dermatomyositis（DM）,and to analyze the risk factors of infection in DM patients.Methods The infections and drug resistance in 307 DM patients,who had been treated in Huashan hospital between 2002 and 2007,were retrospectively reviewed.The infection sites,pathogens and the tolerance of pathogenic bacteria were investigated.The suspected risk factors of infections in DM patients were selected and then analyzed by chi-square test,and the factors of interest were subjected for Logistic regression analysis.Results Incidence of infection was 35.2%（108/307） in the 307 DM patients.Seventeen death cases were related to respiratory infections.The common infection sites were respiratory tract（76.9%）,urinary tract（13.9%）,oral cavity（13.0%）,and skin（7.4%）.Gram-negative were the most common pathogens of infections in DM patients.The common strains for infections in DM patients included Klebsiella spp.（13.5%）,Acinetobacter（6.2%）,Staphylococcus aureus（10.4%） and Candida albus（33.3%）.Antimicrobial susceptibility tests showed a high proportion of drug resistant bacteria,including 7（38.9%） ESBLs-producing strains and 5（42.1%） strains were MRSA.The gram-negative ones were sensitive to cefoperazone-sulbactam and carbopenems.The infection-related risk analysis suggested that the independent risk factors of infections in DM patients included elder age（β=0.697）,interstitial lung diseases（β=1.466）,dysphagia（β=0.737） and high doses of corticosteroids treatment（β=0.700）.Conclusion DM patients with infection-related risk factors should be watched closely for infections.Respiratory tracts are the most common infectious sites in DM patients,and the infection always leads to unfavouable prognoses.The infections are mainly caused by gram-negative bacteria,so ceftazidime,cefoperazone-sulbactam or carbopenems can be chosen before the result of antimicrobial susceptibility test is available.