医院获得性耐甲氧西林金黄色葡萄球菌肺炎的预后因素分析

Prognostic Factors of Hospital-acquired Methicillin-resistant Staphylococcus aureus Pneumonia

目的对医院耐甲氧西林金黄色葡萄球菌(MRSA)肺炎进行分析,了解MRSA肺炎预后危险因素。方法收集2005年1月1日-2008年12月31日医院住院患者痰培养出MRSA的病例(年龄≥18岁),对其进行回顾性对照研究,采用Logistic回归分析危险因素。结果共有116例,多因素Logistic回归分析筛查出7个因素差异有统计学意义(P<0.05),5个危险因素:多器官功能衰竭、血清Na+≥146mmol/L、年龄≥75岁、吸烟、MRSA未清除(OR值:696.775、95.429、42.760、12.847、8.579);2个保护性因素:使用万古霉素总剂量(>9g)、病程中使用万古霉素(OR值:1.025E-02、9.463E-02)。结论医院获得性MRSA肺炎的危险因素较多,尽早进行足量的抗菌药物经验治疗对疾病预后有重要影响。

OBJECTIVE To determine the prognostic factors of adult inpatients with hospital-acquired MRSA pneumonia.METHODS All the medical records of consecutive patients aged ≥18 ea with diagnosis of meticillin-resistant Staphylococcus aureus（MRSA） pneumonia from Jan.2005 to Dec.31 2008 were searched for a retrospective analysis with case-control study.Contribution of risk factors to prognosis was determined by multivariate analysis with Logistic regression.RESULTS All 116 hospital-acquired MRSA were identified.There were seven factors associated with prognosis on multivariate analysis：5 risk factors,MODS,Na＋≥146 mmol/L,age ≥75 ea,cigarrete,and failure of MRSA remove（their OR value 696.775,95.429,42.760,12.847,and 8.579,respectively）;2 protective factors,dose of vancomycin（9 g） and use of vancomycin（their OR value 1.025E-02 and 9.463E-02）.CONCLUSIONS There are many risk factors contributive to hospital-acquired MRSA pneumonia.Initial appropriate antibiotic empiric therapy is important to the prognosis.