血液病住院患者血流感染死亡危险因素分析

Risk Factors for Mortality of Bloodstream Infections in Patients with Hematologic Diseases

【目的】分析血液病住院患者发生血流感染死亡相关的危险因素,为临床评估病情、合理干预及改善预后提供依据。【方法】回顾性分析2012年1月到2016年6月发生血流感染的血液病患者临床特征及死亡相关的危险因素,采用SPSS 19.0统计软件进行数据处理。【结果】共纳入242例次血培养阳性血流感染患者,分离出266株病原菌,其中革兰阳性菌99株(37.2%),革兰阴性菌164株(61.7%),真菌3株(1.1%)。血流感染患者死亡42例(17.4%),Logistic多因素回归分析显示原发病活动状态(P=0.007,OR=5.622,95%CI 1.586~19.924)、出现感染性休克(P=0.007,OR=4.978,95%CI 1.560~15.884)、合并心功能不全(P=0.001,OR=11.878,95%CI 2.760~51.120)、白蛋白水平<35 g/L(P=0.036,OR=3.468,95%CI 1.087~11.066)、多种病菌感染(P=0.010,OR=6.024,95%CI 1.540~23.563)以及感染病菌为肠球菌属(P=0.002,OR=15.266,95%CI 2.817~82.728)或溶血性葡萄球菌(P=0.001,OR=19.308,95%CI 3.392~109.888)为死亡独立危险因素。Kaplan-Meier生存分析显示,不恰当的初始经验性抗菌治疗及具备任何一个上述危险因素的患者总体病死率明显升高。【结论】血液病患者血流感染病原菌种类多,多重耐药菌检出率高,死亡率高。及时并合理使用抗菌药物、积极治疗原发病、改善心功能和及时纠正低蛋白血症是改善预后的关键措施。

[ Objective ] To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases, so as to provide evidence for reasonable and effective application of treatments. [ Methods ] The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively, then the analysis was performed for risk factors. The statistical analysis was processed by SPSS 19.0. [ Results ] A total of 266 strains of pathogens were isolated, including 99 strains of gram-positive bacteria, accounting for 37.2%, and 164 strains of gram-negative bacteria, account- ing for 61.7%. Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases （P = 0.007, OR = 5.622,95% CI 1.586 - 19.924）, presentation with septic shock （P = 0.007, OR = 4.978,95% CI 1.560 15.884） , cardiac insufficiency （P = 0.001, OR = 11.878,95% CI 2.760 - 51.120） , level of albumin less than 35 g/L （P = 0.036, OR = 3.468,95% CI 1.087 - 11.066）, polymicrohial infection （P = 0.010, OR = 6.024,95% CI 1.540 - 23.563）, and Staphylococ- cus haemolyticus （P = 0.001, OR = 19.308,95% CI 3.392 - 109.888）/Enterococeus （P = 0.002, OR = 15.266, 95% CI 2.817 - 82.728） infection. The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group. [Conclusions] Bloodstream infections in patients may cause high mortality rate, so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.