医院获得性耐甲氧西林金黄色葡萄球菌肺炎临床转归影响因素分析

Analysis of influencing factors of the clinical outcome in hospital-acquired methicillin resistant Staphylococcus aureus pneumonia

目的研究医院获得性耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的临床和病原体特点,分析影响临床转归的风险因素。方法回顾性分析113例MRSA引起的医院获得性肺炎患者,根据入院后30d是否存活将其分为存活组和死亡组,比较两组患者临床和病原体特点,采用多因素Logistic回归分析影响临床转归的风险因素。结果 113例MRSA肺炎患者有53例在30d内死亡,死亡率为46.9%。死亡组与存活组在年龄、PSI评分、糖尿病、类固醇激素使用、SCCmecⅣ型基因、PVL阳性、万古霉素MICs比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄(>75岁)、PSI评分(>145分)、PVL阳性是影响医院获得性MRSA肺炎预后的风险因素(P<0.05)。结论医院获得性MRSA肺炎临床死亡率较高,年龄(>75岁)、PSI评分(>145分)、PVL阳性是影响临床预后的高风险因素。

Objective To investigate the clinical and pathogenic characteristics of hospital acquired methicillin resistant Staphylococcus aureus（ MRSA） pneumonia,and to analyze the risk factors affecting the clinical outcome. Methods A retrospective analysis of 113 patients with hospital acquired pneumonia caused by MRSA were divided into the survival group and the death group according to the survival of 30 d after admission. The clinical and pathogenic characteristics of the two groups were compared and the risk factors of clinical outcomes were analyzed by multiple factor Logistic regression. Results The mortality was 37. 1% in 113 patients with MRSA pneumonia. There was a statistically significant difference in age,PSI score,diabetes,steroid use,SCCmec IV genotype,PVL positive and vancomycin MICs between the death group and the survival group（ P〈0. 05）. Multivariate Logistic regression analysis showed that age（ 〉75 years old）,PSI score（〉 145 points） and PVL positivity were the risk factors for the prognosis of hospital acquired MRSA pneumonia（ P〈0. 05）. Conclusion It has a higher clinical mortality for hospital acquired MRSA pneumonia,age（ 〉75 years old）,PSI score（ 〉145 points） and PVL positivity are the high risk factors for the prognosis.