成人金黄色葡萄球菌血流感染133例的危险因素及预后分析

Risk factor and prognosis profiling in 133 adults with Staphylococcus aureus bloodstream infection

目的探讨133例成人金黄色葡萄球菌血流感染的相关危险因素及对患者预后的影响。方法对2013年1月-2017年12月确诊为金黄色葡萄球菌血流感染133例患者进行回顾性调查分析。结果133例患者均系医院感染,其中36例检出耐甲氧西林金黄色葡萄球菌(MRSA),检出率为27.1%(36/133),97例检出甲氧西林敏感金黄色葡萄球菌(MSSA),检出率为72.9%(97/133)。除对甲氧苄啶-磺胺甲唑外,MRSA组对常用抗菌药物的耐药率均高于MSSA组,未发现对万古霉素、替考拉宁和利奈唑胺耐药株。MRSA组年龄≥65岁,呼吸衰竭,住院急诊,入住ICU,手术,使用有创呼吸机、导尿管、中心静脉导管显著高于MSSA组(P均<0.05);MRSA组患者病死率高于MSSA组(25.0%比5.2%),差异有统计学意义(P<0.05);MRSA组预后不良发生率高于MSSA组(41.7%比24.7%)(P<0.05),差异有统计学意义;MRSA组总住院时间长于MSSA组(24d比16d),差异有统计学意义(P<0.05);多因素分析结果显示:年龄≥65岁、入住ICU是预后不良的独立危险因素。结论MRSA感染所致的病死率较MSSA高,MRSA血流感染增加患者住院时间,年龄≥65岁、入住ICU是预后不良的独立危险因素。

Objective To evaluate the risk factors for isolation of Staphylococcus aureus strains from bloodstream infections and corresponding patient prognosis.Methods A retrospective analysis was conducted on 133 adults with diagnosis of hospital-acquired S.aureus bloodstream infection from January 2013 to December 2017.Results MRSA was identified from 36 (27.1%) of the 133 S.aureus isolates,and the remaining 97 (72.9%) strains were methicillin-susceptible (MSSA).MRSA strains showed significant higher resistance rate than MSSA to most antibiotics with exception of trimethoprim-sulfamethoxazole.No S.aureus strain was found resistant to vancomycin,teicoplanin or linezolid.Old age (≥ 65 years),respiratory failure,emergency room admission,ICU stay,surgical operation,mechanical ventilation,urethral catheter,and central venous catheter were more prevalent in the patients with MRSA-associated bloodstream infection (P<0.05).The mortality and incidence of poor outcome were numerically higher in the patients with MRSA-associated bloodstream infection than in the patients with MSSA-associated bloodstream infection (25.0% vs.5.2% and 41.7% vs.24.7%,respectively,P<0.05). The length of hospital stay in the patients with MRSAassociated bloodstream infection was significantly longer than that in the patients with MSSA-associated bloodstream infection (24 d vs.16 d,P<0.05).Multivariate analysis showed that old age (≥65 years) and ICU stay were independent risk factors for poor prognosis.Conclusions MRSA bloodstream infection is associated with higher mortality than MSSA bloodstream infection.MRSA bloodstream infection increased the length of hospital stay.Old age (≥65 years) and ICU stay were independent risk factors for poor prognosis.