社区获得性血流感染临床分析

Clinical Analysis of Community-Acquired Bloodstream Infection

目的研究南方医科大学附属顺德第一人民医院社区获得性血流感染(CABSI)的病原学以及临床特点。方法回顾性分析2010至2011年入住南方医科大学附属顺德第一人民医院且血培养阳性的病例资料,筛选出临床诊断符合CABSI病例,并对其病原学以及临床特点进行统计分析。结果共筛选出CABSI病例106例,分离出110株病原菌,其中革兰阴性菌80株(72.7%),革兰阳性菌30株(27.3%)。59例(55.7%)患者临床能明确细菌来源,排名前三位的是泌尿生殖道、腹腔、下呼吸道。住院期间死亡22例(20.8%),单因素分析显示肝胆系统疾病、恶性肿瘤、下呼吸道来源与CABSI住院期间死亡相关(P<0.05),多因素分析显示恶性肿瘤、下呼吸道来源是CABSI住院期间死亡的独立危险因素。结论本地区CABSI病原菌仍以革兰阴性菌为主,恶性肿瘤、下呼吸道来源是CABSI住院期间死亡的独立危险因素。

Objective To evaluate the etiological and clinical characteristics of community-acquired bloodstream infection （CABSI） at Shunde First People＇s Hospital Affiliated to Southern Medical University. Methods The clinical data of the hospitalized patients were analyzed retrospectively from 2010 to 2011 in Shunde First People＇s Hospital Affiliated to Southern Medical University, who had positive blood culture. Patients diagnosed as CABSI included in this study. The microbiological and clinical characteristics were statistically analyzed. Results One hundred and ten strains of microbes were isolated from 106 patients with CABSI, including gram-negative bacteria （80, 72.7%） and Gram-positive bacteria （30, 27.3%）. Fifty-five （55.7%） patients had identified source of BSI, urogenital tract infections, intraabdominal infections, lower respiratory tract infections were the primary source. Twenty-two （20.8%） patients died during hospitalization, hepatobiliary diseases, malignant tumors and the source of lower respiratory tract infections were associated with death during hospitalization （P 〈0.05）. In the multivariate regression, malignant tumors and the source of lower respiratory tract infections were independent risk factors of death during hospitalization. Conclusions A Gram negative bacterium is the commonest pathogen of CABSI. Malignant tumors and the source of lower respiratory tract infections are independent risk factors of death during hospitalization.