医院获得性铜绿假单胞菌血流感染临床特征及死亡危险因素分析

Clinical characteristics and risk factors for mortality of hospital-acquired Pseudomonas aeruginosa bloodstream infections

目的探讨医院获得性铜绿假单胞菌血流感染患者的临床特征及死亡危险因素,为临床救治提供依据。方法收集本院2010年1月-2014年12月医院获得性铜绿假单胞菌血流感染患者的临床资料,对其临床特点和死亡危险因素进行回顾性分析。结果 136例患者入选本研究,其中男性96例,女性40例,平均年龄为(52.9±23.36)岁。130例(95.59%)发热,86例(63.24%)伴寒战;100例(73.52%)白细胞升高或减少,121例(88.97%)C反应蛋白升高。32例死亡,病死率23.53%,死亡单因素分析显示,年龄>70岁、APACHEⅡ评分、肺部感染、入住ICU、有创机械通气、多重耐药、血红蛋白<90g/L和白蛋白<35 g/L与死亡相关;Logistic回归分析显示,APACHEⅡ评分、有创机械通气为死亡独立危险因素。结论发热、寒战、白细胞升高或减少、C反应蛋白升高等为医院获得性铜绿假单胞菌血流感染的主要临床特征;高APACHEⅡ评分、有创机械通气为其死亡独立危险因素。

Objective To analyze clinical characteristics and risk factors for mortality of hospital-acquired Pseudomonas aeruginosa bloodstream infections and provide reference for clinical prevention and treatment. Methods Clinical characteristics and risk factors for mortality were analyzed retrospectively based on clinical data about patients with hospital-acquired pseuclomonas aeruginosa bloodstream infection in Chinese PLA General Hospital from January 2010 to December 2014. Results A total of 136 patients were enrolled in this study, including 96 males and 40 females, of which, 130 patients（95.59%） had fever, 86 cases（63.24%） were with chills, 100 cases（73.52%） were with high or low white blood cell counts and 121 cases（88.97%） were with high level of C-reactive protein. A total of 32 patients died. Factors associated with mortality in univariate analysis included age〉70 years old, APACHE Ⅱ score, pulmonary infection, ICU admission, invasive mechanical ventilation, multiple drug resistance, hemoglobin〈90 g/L, and albumin〈35 g/L. Logistic regression analysis showed that high APACHEⅡ score and invasive mechanical ventilation were risk factors for mortality of bloodstream infection caused by Pseudomonas aeruginosa. Conclusion Fever, chill, abnormal white cell counts and high level of C-reactive protein are common features of Pseudomonas aeruginosa bacteremia bloodstream infection. High APACHE Ⅱ score and invasive mechanical ventilation are independent risk factors for mortality.