杭州地区社区获得性血流感染与医院血流感染的临床及病原学研究

Comparison of Community-acquired and Nosocomial Bloodstream Infection in Hangzhou Area.

目的比较近年来杭州地区社区获得性血流感染（CABSI）与医院血流感染（NBSI）的临床特点及病原菌分布。方法调查2004-2008年入住杭州市第一人民医院、血培养阳性并确诊为血流感染的病例,对其临床特点及病原菌分布进行统计分析。结果确诊为血流感染者共397例,获病原菌405株。其中CABSI 261例（65.7%）,NBSI 136例（34.3%）。CABSI的平均年龄39.87±31.41岁,病死率1.9%,合并基础疾病率65.1%;NBSI的平均年龄65.10±19.02岁,病死率14.0%,合并基础疾病率97.1%,P均〈0.01。CABSI获病原菌263株,病原菌中以凝固酶阴性葡萄球菌（CNS）最常见,占27.4%,余依次为大肠杆菌、克雷伯菌属、阴沟肠杆菌、链球菌属等。NBSI病原菌142株,病原菌中以大肠杆菌最常见,占19.7%,余依次为凝固酶阴性葡萄球菌、白色念珠菌等念珠菌属、伯克霍尔德菌属、铜绿假单胞菌等。结论 CABSI患者与NBSI比较,发病年龄较轻、合并基础疾病较少、治愈率较高,病原菌以CNS居首位,NBSI则以大肠杆菌最常见。临床上应对CABSI抑或NBSI加以区分、分析可能的致病菌,对了解地区差异、判断预后、减少病死率甚为重要。

Objective To compare the clinical characteristics and bacterial distribution of community-acquired（CABSI） and nosocomial（NBSI） bloodstream infection in Hangzhou area.Methods Records with positive blood culture from 2004 to 2008 in Hangzhou First People′s Hospital were examined.We analyzed the clinical characteristics and bacterial distribution of the cases diagnosed bloodstream infection.Results 397 episodes were diagnosed and 405 pathogenic isolates were collected.Of all the BSI episodes,65.7% BSI were CABSI and 34.3% were NBSI.The average age was 39.87±31.41 year for CABSI vs 65.10±19.02 year for NBSI（P0.01）.The mortality was 1.9% for CABSI versus 14.0% for NBSI（P0.01）.Underlying illnesses accompanying bloodstream infections auaunted for 65.1% and 97.1% in CABSI and NBSI,respectively（P0.01）.The commonest pathogen causing CABSI was coagulase-negative staphylococcus（CNS）（27.4%）,followed by Escherichia coli,Klebsiella pneumoniae,Enterobacter cloacae,Streptococcus.Esche-richia coli was the leading pathogen causing NBSI,followed by CNS,Candidaspecies,Burkholderi spp,Pseudomonas aeruginosa.Conclusion The average age is younger for patients with CABSI vs NBSI.The incidence of underlying illnesses is lower among patients with CABSI vs NBSI.The cure rate is higher for patients with CABSI vs NBSI.CNS is the commonest pathogen of CABSI.Escherichia coli is the leading pathogen causing NBSI.Distinguishing between CABSI and NBSI and analyzing the possible pathogens of CABSI and NBSI are needed to provide useful information of geographic differences and to reduce mortality.