血流感染耐甲氧西林金黄色葡萄球菌对患者预后的影响

Impact of methicillin-resistant Staphylococcus aureus bloodstream infection on the prognosis of patients

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)感染对患者住院时间、院内死亡以及不良预后的影响。方法对2009年1月1日—2013年12月31日华西医院血培养确诊为金黄色葡萄球菌感染的357例住院患者进行回顾性调查分析。结果 357例患者,MRSA感染91例,甲氧西林敏感金黄色葡萄球菌(MSSA)感染266例。MRSA组和MSSA组住院时间比较(29 d vs 23 d),差异有统计学意义(P<0.01);感染前MRSA组患者住院时间长于MSSA组(P<0.01),感染后两组患者住院时间比较(17 d vs 16.5 d),差异无统计学意义(P=0.92)。MRSA组和MSSA组患者死亡率比较(13.19%vs 9.02%),差异无统计学意义(χ2=1.28,P=0.26);MRSA组不良预后发生率为29.67%,高于MSSA组的16.92%(χ2=6.85,P=0.01)。多因素分析结果显示,MRSA感染是患者预后不良的独立危险因素(P<0.01)。结论 MRSA感染未增加患者住院时间,但MRSA血流感染是患者不良预后的危险因素。

Objective To understand the impact of methicillin-resistant Staphylococcus aureus （MRSA）blood-stream infection on the length of hospital stay,hospital mortality,and poor prognosis of patients.Methods 357 patients with Staphylococcus aureus （S .aureus）bacteremia in a hospital between January 1 ,2009 and December 31 , 2013 were surveyed and analyzed retrospectively.Results Of 357 patients,91 were infected with MRSA and 266 with methicillin-susceptible S .aureus （MSSA）.The length of hospital stay was statistically different between MR-SA and MSSA group（29 d vs 23 d,P 〈0.01）;before infection,length of hospital stay of MRSA group was longer than MSSA group（P 〈0.01 ）;after infection,length of hospital stay was not statistically different between two groups（17 d vs 16.5 d,P = 0.92 ）.Mortality of MRSA group and MSSA group was not statistically different （13.19% vs 9.02%,χ^2 =1 .28,P =0.26）.The incidence of poor prognosis of MRSA group was higher than MSSA group（29.67% vs 16.92%,χ^2 =6.85,P =0.01 ）.Multivariate analysis results showed that MRSA infection was independent risk factor for poor prognosis （P 〈0.01）.Conclusion MRSA infection doesn’t contribute to the pro-longation of hospital stay,but MRSA bloodstream infection is a risk factor for poor prognosis of patients.