多重耐药菌血行感染的预后危险因素分析

Analysis of risk factors for prognosis of bloodstream infection with multidrug-resistant organisms

目的:分析多重耐药菌血行感染患者的临床和微生物特征,评价其死亡危险因素,以指导临床治疗。方法:回顾性分析2015-01—2017-12期间广东省中医院收治的371例多重耐药菌血行感染的临床资料,分析病原菌种类、基础疾病、危险因素、预后情况,使用单因素和多因素logistic回归分析多重耐药菌血行感染死亡的相关危险因素。结果:进展为多器官功能障碍综合征、恶性肿瘤基础疾病、免疫抑制、肺部感染引起的血行感染、鲍曼不动杆菌感染是死亡的独立危险因素。结论:针对死亡独立危险因素,早期监测,早期评估,及时明确感染病原体和原发感染灶,发现转移性感染灶,合理规范使用抗生素,对高危患者进行集束化治疗,可能有助改善预后。

Objective：To observe the clinical and microbiological characteristics of bloodstream infection with multidrug-resistant organisms and to evaluate the risk factors for the prognosis of death so as to provide guidance for clinical treatment.Method：The clinical data of 371 patients with bloodstream infection with multidrug-resistant organisms who were treated in Guangdong provincial hospital of traditional Chinese medical from Jan 2015 to Dec2017 were retrospectively analyzed.The distribution of pathogens,underlying diseases,risk factors and prognosis were observed.The univariate analysis and multivariate logistic regression analysis were carried out to investigate the related risk factors for death of patients with bloodstream infection with multidrug-resistant organisms.Result：The independent risk factors for the death included progressing to MODS,basic diseases of malignant tumors,immune tolerance,bloodstream infection causing by pulmonary infection,baumannii infection.Conclusion：According to the independent risk factors of death,early surveillance,early assessment,timely identification of infected pathogens and primary infectious foci,detection of metastatic infectious foci,rational and standardized use of antibiotics,cluster therapy for high-risk patients,may help to improve the prognosis.