金黄色葡萄球菌血流感染治疗失败的相关危险因素分析

Analysis on the Risk Factors Associated with the Failure of Treatment for Bloodstream Infection with Staphylococcus Aureus

目的分析金黄色葡萄球菌血流感染治疗失败的相关危险因素。方法回顾性分析124例金黄色葡萄球菌血流感染患者的临床资料,以30 d作为判定治疗是否失败的节点,其中治疗失败组占33.87%(42/124),治疗成功组占66.13%(82/124);对比两组的性别、年龄、合并症、入住ICU、感染来源、感染来源危险分层、使用免疫抑制剂、2周内使用抗生素、发生感染性休克、早期治疗反应、APACHEⅡ评分、既往血培养阳性,并进行多因素Logistic回归分析。结果两组的年龄,合并糖尿病,入住ICU,感染来源于导管、肺炎及多来源,使用免疫抑制剂,2周内使用抗生素,发生感染性休克,早期治疗反应,APACHEⅡ评分,既往血培养阳性差异显著(P<0.05);多因素Logistic回归分析显示,多部位感染、发生感染性休克、既往血培养阳性和早期治疗反应均为金黄色葡萄球菌血流感染治疗失败的独立影响因素。结论金黄色葡萄球菌血流感染治疗失败的相关危险因素具有多样性,应根据患者是否存在多部位感染,及早进行血培养检查,评估感染性休克发生风险,观察早期治疗反应,综合评估治疗失败的风险,为临床治疗提供依据。

Objective To analyze the risk factors associated with the failure of treatment for bloodstream infection with staphylococ- cus aureus. Methods The clinical data of 124 patients with bloodstream infection with staphylococcus aureus were analyzed retrospectively. 30 d was used as the node to determine the failure of the treatment, all patients were divided into the successful treatment group （66.13%, 82/124） and the failed treatment group （33.87%, 42/124）. The gender, age, comorbidities, admission to ICU, source of infection, source of infection risk stratification, use of immunosuppressive agents, use of antibiotics within 2 weeks, occurrence of septic shock, early treatment re- sponse, APACHE I1 score, and positive previous blood culture were compared between two groups, and multivariate Logistic regression analysis was made. Results The differences of age, complicated diabetes, admission to ICU, source of infection （catheter, pneumonia and multi-source）, use of immunosuppressive agents, use of antibiotics within 2 weeks, occurrence of septic shock, early treatment response, A- PACHE II score, and positive previous blood culture between two groups were statistically significant （P〈0.05）. Multivariate Logistic regres- sion analysis showed that, multi-site infection, occurrence of septic shock, positive previous blood culture and early treatment response were the independent factors of treatment failure for bloodstream infection with staphylococcus aureus. Conclusions The risk factors for treat- ment failure of bloodstream infection with staphylococcus aureus are diverse. According to whether there is multiple-site infection, early blood culture examination should be taken to assess the risk of occurrence of septic shock and to observe the early treatment response so as to have a comprehensive assessment of the risk of treatment failure, thus providing the basis for clinical treatment.