铜绿假单胞菌血流感染251例临床分析

Clinical analysis of 251 cases of Pseudomonas aeruginosa bloodstream infection

目的探讨铜绿假单胞菌血流感染的临床特点。方法回顾性分析苏州大学附属第一医院2007年1月-2016年12月251例铜绿假单胞菌血流感染患者的临床资料。结果 251例患者入院时的急性生理与慢性健康评分(APACHE Ⅱ评分)11.5±5.2;发热247例;白细胞减少125例、升高87例;中性粒细胞减少122例,其中粒细胞缺乏113例;贫血193例;低白蛋白血症120例。219例患者(87.3%)存在至少1项基础疾病,多数为恶性血液病、恶性实体肿瘤等。血培养前1周有229例患者(91.2%)进行深静脉置管、留置导尿、机械辅助通气等侵袭性操作;行深静脉置管173例,其中108例导管血培养铜绿假单胞菌阳性。在血培养前1个月内有130例患者有放疗或化疗史,124例有免疫抑制剂使用史。251例患者分离铜绿假单胞菌药敏结果显示对阿米卡星敏感率最高(87.3%,219/251),其次为环丙沙星(85.7%,215/251)、头孢吡肟(81.6%,146/179);分离菌株中,多重耐药36株(14.3%),广泛耐药7株。所有患者均接受抗菌药物治疗,主要为β内酰胺酶抑制剂复合制剂、碳青霉烯类和氟喹诺酮类。死亡20例(8.0%),因病情危重而放弃治疗者37例(14.7%),好转194例(77.3%)。logistic回归分析显示入院时高APACHE Ⅱ评分、贫血、低白蛋白血症为预后不佳的独立危险因素。结论铜绿假单胞菌血流感染好发于免疫功能受损的患者,高APACHE Ⅱ评分、贫血、低白蛋白血症者预后差,及时恰当的经验性治疗可改善预后。

Objective To review the clinical characteristics and risk factors of Pseudomonas aeruginosa bloodstream infections.Methods The clinical data of P.aeruginosa bloodstream infections in the First Affiliated Hospital of Soochow University from January 2007 to December 2016 were analyzed retrospectively.Results Of the 251 patients identified,APACHEⅡscore on admission was 11.5±5.2.Majority(98.4%,247/251)of the patients had fever.Leukopenia was found in 125 patients,leukocytosis in 87 patients,neutropenia in 122 patients,agranulocytosis in 113 patients,anemia in 193 patients,and hypoalbuminemia in 120 patients.Overall,219 patients had at least one underlying disease,primarily hematological malignancy,or malignant solid tumor.Most(229)patients received invasive procedures such as deep venous catheter,urinary catheter,mechanical ventilation before blood sampling.P.aeruginosa was isolated from 108 of the 173 deep venous catheters.In addition,130 patients received radiation or chemotherapy.Immunosuppressive agents were used in 124 patients.Among the 251 strains of P.aeruginosa,87.3%were susceptible to amikacin,followed by ciprofloxacin(85.7%)and cefepime(81.6%).Multidrug-resistant P.aeruginosa was isolated from 36(14.3%)patients,and extensively drug resistant strain was isolated from 7 patients.All the 251 patients were treated with antimicrobial agents,mainlyβ-lactam/β-lactamase inhibitor combinations,carbapenems or fluoroquinolones.Overall,20(8.0%)of the 251 patients died,37(14.7%)refused further therapy due to worsening condition,and 194(77.3%)improved.Binary logistic regression analysis showed that high APACHE II score on admission,anemia and hypoalbuminemia were risk factors for poor outcome of bloodstream infections caused by P.aeruginosa.Conclusions P.aeruginosa bloodstream infection occurs more readily in immunocompromised patients.High APACHEⅡscore on admission,anemia and hypoalbuminemia are associated with poor prognosis.Appropriate empiric antimicrobial treatment as early as possible can improve the prognosis of P.aeruginosa bloodstream infection.