万古霉素MIC值与MRSA菌血症患者病死率的关系

Relationship of vancomycin MIC and mortality in patients with MRSA bacteremia

目的研究在敏感范围内的万古霉素最低抑菌浓度(MIC)值与金黄色葡萄球菌菌血症患者病死率的关系,为临床医生用药提供参考。方法收集2011年1月至2014年6月分离自住院患者血培养阳性的金黄色葡萄球菌,对金黄色葡萄球菌及耐甲氧西林金黄色葡萄球菌(MRSA)用VITEK-II全自动微生物分析系统进行鉴定及药敏检测,并对患者的临床资料进行回顾性分析。结果根据万古霉素MIC值为2μg/ml、1μg/ml和≤0.5μg/ml将患者分为高MIC组、中MIC组和低MIC组,金黄色葡萄球菌相关病死率在三组中无显著差异,MRSA相关病死率在三组中也无显著差异。逻辑回归分析结果显示,出现肾功能不全或肺炎对金黄色葡萄球菌菌血症及MRSA菌血症患者的病死率的影响有统计学意义。结论在敏感范围内万古霉素MIC值与MRSA菌血症患者30天病死率无关。肾功能不全、肺炎是影响MRSA菌血症患者30天病死率的独立因素。

Objective To study the relationship of vancomycin MIC in the range of sensitive and mortality in patients with MRSA bactere- mia, and to provide the reference of drug use to treat MRSA bacteraemia for clinicians. Methods All patients with an Staphylococcus aureus bloodstream infection who were hospitalized in our hospital in China from January 2011 to June 2014 were included into this study. Stain identifica- tion and antimicrobial susceptibilities of Staphylococcus aureus and MRSA were determined using VITEK - II automatic microbial analysis system. Results There was no significant difference in attributable mortality or 30 - day mortality among high - MIC group （ MIC = 2 μg/ml）, middle - MIC group （MIC = 1 μg/ml） and low- MIC group （MIC〈0.5 μg/ml）. By Logistic regression analysis, renal insufficiency and pneumonia were found to be associated with attributable 30 - day mortality. Conclusion Our study suggests that a high vancomycin MIC in a range are not associ- ated with mortality, but patients with renal insufficiency and patients with pneumonia are predictors of all - cause 30 - day mortality.