根除感染灶改善院内金黄色葡萄球菌血流感染预后研究

Focus eradication improved the inpatient's outcome of staphyloccocus aureus-blood stream infection

目的探讨住院患者发生金黄色葡萄球菌血流感染（SA—BSI）时的病灶特征和治疗方式，以期改善上述患者预后。方法回顾性分析2009年1月至12月北京协和医院47例SA—BSI住院患者的临床资料，根据病灶特征将患者进行分类。采用Logistic回归模型进行多因素分析影响患者预后的危险因素。结果47例SA—BSI相关病死率为42．6％（20／47），住院病死率为51．1％。24例（51．1％）血流感染（BSI）后发生了感染性休克，病死率70．8％（17／24）。31例（66．0％）感染灶不可根除，16例（34．0％）可被根除，两组患者SA—BSI相关病死率差异无统计学意义[48．4％（15／31）对31．2％（5／16），P=0．26]。13例（27．7％）进行了感染灶根除，与感染灶未根除患者比较具有更好的预后[15．5％（2／13）对52．9％（18／34），P=0．020]。Logistic回归分析结果显示感染灶根除（OR0．135，95％C10．020～0．923，P=0．041）、BSI后感染性休克（OR17．921，95％CI3．581～89．684，P〈0．001）是影响患者茵血症相关性病死的独立因素。结论根除感染灶阻止感染性休克可降低SA—BSI病死率，改善患者预后。

Objective To explore focus characteristics and treatment strategy of staphyloecocus aureus-Blood stream infec-tion （ SA-BSI）, in the hope pf improving the outcome of SA-BSI inpatients. Methods The clinical data of 47 SA-BSI inpa-tients in Peking Union Medical College Hospital from Jan. to Dec. in 2009 were retrospectively analyzed and classified by the infection focus characteristics. Logistic regression analysis was done to explore the potential risk factors that affect the outcome of SA-BSI. Results The mean age was 59. 5 ± 19. 7 years, and mean hospital length of stays was 59. 6 ± 60. 8 days. Related mortality was 42. 6% （20/47） and admission mortality was 51.1% （24/47） in all the patients. Septic shock occurred in 24 patients following BSI （51.1% ） , associated with a bacteremia related mortality of 70. 8% （17/24）. Infec-tion Foci of 31 patients （66. 0% ） were not eradicable, and loci of 16 patients （34. 0% ） were eradicable. No significant difference in bacteremia related mortality, however, was observed between these two groups （48.4 % E 15/31 1 vs 31.2% [ 5/16 ] ,P = 0. 26）. Thirteen patients （27.7%） underwent focus eradication. Compared with those without focus eradica-tion, they had better outcome （ 15.5% [ 2/13 ] vs 52. 9% [ 18/34 ] ,P = 0. 020）. In all the patients,logistic regression showed that focus eradication （OR 0. 135,95% CI 0. 020 -0. 923 ,P = 0. 041 ） and septic shock following BSI （OR 17. 921,95% CI 3. 581 - 89. 684 ,P 〈 0. 001 ） were independent risk factors associated with baeteremia related mortality. Condusion Focus eradication and prevention of septic shock improve SA-BSI patient outcome.