2008-2015年深圳某医院金黄色葡萄球菌血流感染的临床特征和预后分析

Bloodstream infections caused by Staphylococcus aureus in a university hospital center in Shenzhen,2008-2015

目的分析深圳市南山区人民医院金黄色葡萄球菌血流感染的临床特征和起病后30 d内死亡相关的危险因素。方法回顾分析2008-2015年由金黄色葡萄球菌所致血流感染患者的临床和微生物学资料,分析30 d内死亡相关危险因素。结果共121例患者入组,其中MRSA血流感染检出率为17.4%(21/121)。相比较于MSSA血流感染,MRSA血流感染中年龄≥65岁老年患者更多、医院感染和呼吸道感染更为常见(P值分别为0.026、0.035和0.001);并且MRSA血流感染患者中复数菌感染更多和接受了更多的不恰当初始抗感染治疗(P值分别为0.005和0.001)。患者起病后30 d内的死亡率为18.2%(22/121)。通过单因素和多因素回归分析示仅实体肿瘤(OR,8.932,P=0.004)和感染性休克(OR,56.721,P<0.001)是患者起病后30 d内死亡的独立危险因素。结论实体肿瘤和感染性休克,比MRSA感染在金黄色葡萄球菌血流感染患者死亡中起了更重要的作用。

Objective This study was designed to examine the clinical characteristics of bloodstream infections （BSI） caused by Staphylococcus aureus in a teaching hospital and the risk factors for 30-day mortality. Methods A single center retrospective cohort study was conducted for all the patients with BSI caused by S. aureus between 2008 and 2015. The data of clinical features, microbiology, and 30-day mortality were collected from the database of electronic medical records. Results A total of 121 patients with S. aureus BS1 were identified. The prevalence of methicillin-resistant S. aureus （MRSA） was 17.4% （21/121）. MRSA BSIs were significantly associated with old age （≥65 years） （P=0.026）, hospital acquired infection （P=0.035）, respiratory tract infection （P=0.001）, polyinfection （P=0.005） and inappropriate initial antibiotic therapy （P=0.001） than methicillin-sensitive S. aureus （MSSA） BSIs. The 30-day mortality was 18.2% （22/121）. Both univariate and multivariate analysis suggested that solid tumor （OR, 8.932, P=0.004） and septic shock （OR, 56.721, P〈0.001） were independently associated with the 30-day mortality. Conclusions Thepresent study confirms that solid tumor and septic shock arc more important risk factors than MRSA in mortality of patients with S. aureus BSI.