ICU血流感染病原菌分布特点及预后危险因素分析

Distribution of pathogens causing bloodstream infectionin ICU and analysis of risk factors for prognosis

目的探讨重症监护病房(ICU)血流感染病原菌的分布特点及影响预后的危险因素。方法对76例血流感染患者的临床资料进行回顾性分析。结果 76例患者共检出89株病原菌,革兰阴性菌、革兰阳性菌和真菌分别占55.1%、35.9%和8.9%。其中,肺炎克雷伯菌占革兰阴性菌的28.5%,金黄色葡萄球菌和凝固酶阴性葡萄球菌分别占革兰阳性菌的34.3%和40.6%。共检出41株多重耐药菌株,其中12株革兰阴性菌为耐碳青霉烯菌株。对死亡组和生存组资料进行单因素分析结果显示MODS评分≥9分(72.4%与25.5%)、APACHEⅡ评分≥18分(75.8%与19.1%)、多重耐药菌感染(72.4%与34.0%)、持续肠外营养(62.1%与23.4%)及年龄≥65岁(65.5%与38.3%)的差异有统计学意义。logistic回归分析结果显示多重耐药菌感染、持续肠外营养、MODS评分和APACHEⅡ评分是影响预后的独立危险因素。结论 ICU血流感染病原菌分布较广,多重耐药菌尤其是耐碳青霉烯细菌是临床抗感染的难点。多重耐药菌感染、持续肠外营养、MODS评分和APACHEⅡ评分是影响预后的独立危险因素。

Objective To investigate the pathogen distribution of bloodstream infection（BSI） in ICU and the risk factors for prognosis.Methods The clinical data of 76 cases of bloodstream infection were retrospectively analyzed.Results Totally,89 strains of pathogens were isolated from the 76 cases.Gram-negative bacteria,gram-positive bacteria and fungi accounted for 55.1％,35.9％ and 8.9％,respectively.Among them,the klebsiella pneumoniae accounted for 28.5％ of the gram-negative bacteria,while the staphylococcus aureus and the coagulase negative staphylococi accounted for 34.3％ and 40.6％ of the gram-positive bacteria,respectively.Forty-one strains were confirmed as multiple drug-resistant ones,12 of which were resistantto carbapenem.A single factor analysis was conducted and the result revealed that MODS score （≥ 9） （72.4％ vs 25.5％）,APACHE Ⅱ score （≥ 18） （75.8％ vs 19.1％）,multiple drug-resistant infection （72.4％ vs 34.0％）,continuous parenteral nutrition （62.1％ vs 23.4％,）andage（≥65） （65.5％ vs 38.3％） were statistically different between the death and survival groups.Logistic regression analysis indicated that multiple drug-resistant infection,continuous parenteral nutrition,MODS score and APACHE Ⅱ score were independent risk factors for prognosis.Conclusion The pathogens of BSI have a wide distribution.Multiple drug-resistant bacteria infection,particularly the carbapenem-resistant bacteria infection,is the key problem for anti-infection therapy.Multiple drug-resistant infections,continuous parenteral nutrition,APACHE Ⅱ score and MODS score are independent risk factors for prognosis of BSI.