SICU患者医院获得性血流感染的预后分析

Prognosis of SICU patients with hospital-acquired bloodstream infections

目的了解外科重症监护病房(SICU)患者医院获得性血流感染病原菌分布及患者预后,并分析死亡的危险因素,为临床抗感染治疗提供指导。方法收集医院SICU 2004-2015年确诊为医院获得性血流感染的111例患者的临床资料,对其病原菌分布、预后进行描述性研究,对导致患者死亡的危险因素实施单因素、多因素logistic回归分析;采用SPSS17.0软件对数据进行统计分析。结果 111例血流感染患者的送检标本中共分离出病原菌180株,其中革兰阴性菌84株占46.7%、革兰阳性菌56株占31.1%、真菌40株占22.2%;患者住院期间病死率为44.1%;APHACHEⅡ≥18分、凝固酶阴性葡萄球菌感染、鲍氏不动杆菌感染及多药耐药菌感染是患者死亡的独立危险因素(P<0.05)。结论 SICU患者医院获得性血流感染病原菌种类多样、预后不佳,临床应加强病原菌监测,预防为先,并及时采取有效的抗感染策略。

OBJECTIVE To explore the distribution of pathogens causing hospital-acquired bloodstream infections in patients of surgical intensive care unit（SICU）,analyze the prognosis of the patients,and observe the risk factors for death so as to provide guidance for clinical treatment of the infections.METHODS The clinical data were collected from 111 patients who were confirmed as hospital-acquired bloodstream infections and treated in the SICU from 2004 to 2015,then a descriptive study was conducted for the distribution of pathogens and prognosis,the univariate,multivariate logistic regression analysis was carried out for the risk factors for death,and the statistical analysis of data was performed with the use of SPSS17.0software.RESULTS A total of 180 strains of pathogens were isolated from the submitted specimens of the 111 patients with bloodstream infections,including 84（46.7%）strains of gram-negative bacteria,56（31.1%）strains of gram-positive bacteria,and 40（22.2%）strains of fungi.The mortality rate was 44.1% during the hospital stay.The APHACHEⅡ score no less than 18 points,coagulase-negative Staphylococcus infection,Acinetobacter baumannii infection,and multidrug-resistant bacteria infection were the independent risk factors for the death（P〈0.05）.CONCLUSION There are a variety of species of pathogens causing the hospital-acquired bloodstream infections in the SICU patients,and the prognosis of the patients is poor.It is necessary for the hospital to strengthen the surveillance of pathogens and take effective prevention measures in advance.