老年社区获得性血流感染患者的病原学特点及预后

Etiological characteristics and prognosis of elderly patients with community acquired bloodstream infection

目的分析老年社区获得性血流感染(CABSI)患者的病原菌分布特点及耐药性,探讨影响预后的相关危险因素,为临床诊疗提供参考。方法回顾性分析2015年1月-2018年9月西南医科大学附属医院确诊为CABSI且年龄≥65岁住院患者的血培养及药敏试验结果、临床资料。结果157例老年CABSI患者中121例(77.1%)至少存在1种基础疾病,以2型糖尿病多见。原发感染部位明确者111例(70.7%),以泌尿道感染多见。内分泌科(25.5%,40/157)是病原菌检出率最高的科室。共分离出157株非重复病原菌,其中革兰阴性菌、革兰阳性菌、真菌分别占75.2%(118/157)、21.0%(33/157)、3.8%(6/157)。常见病原菌为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌。在常见革兰阴性菌中,未发现对碳青霉烯类耐药菌株,对氨苄西林耐药率最高。在常见革兰阳性菌中,对利奈唑胺、万古霉素均呈现敏感,而对青霉素耐药率最高。157例CABSI住院患者病死率为17.2%,结合单因素、多因素logistic回归分析结果显示患有2型糖尿病(OR=3.132)和降钙素原升高(OR=1.023)是患者死亡的危险因素。结论老年CABSI患者分离病原菌以革兰阴性菌为主,最常见的病原菌为大肠埃希菌。患2型糖尿病和降钙素原升高是影响患者预后的高危因素。

Objective To analyze the distribution,antibiotic resistance of pathogens in elderly patients with community acquired bloodstream infection(CABSI),and explore the relevant risk factors affecting prognosis,for better clinical diagnosis and treatment.Methods From January 2015 to September 2018,the data of 157 elderly inpatients(≥65 years old)with CABSI in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed,including the results of blood culture and antimicrobial susceptibility test.Results Underlying disease was identified in 121(77.1%)elderly CABSI patients.Type 2 diabetes mellitus was the most common underlying disease.Primary site of infection was reported in 111 cases(70.7%).Urinary tract infection was the most common site of infection.The isolates from Endocrinology Department accounted for the most part(25.5%,40/157).A total of 157 non-duplicate pathogens were isolated,of which 75.2%(118/157)were gram-negative bacteria,21.0%(33/157)were grampositive,and 3.8%(6/157)were fungi.E.coli,K.pneumoniae,and S.aureus were the top 3 pathogens.No carbapenem-resistant strains were found among the common gram-negative bacteria,but the resistance rate to ampicillin was higher in gram-negative bacteria.Gram-positive bacteria were highly sensitive to linezolid and vancomycin,but highly resistant to penicillin.The mortality rate was 17.2%in the 157 patients.Univariate and multivariate logistic regression analysis showed that history of type 2 diabetes mellitus(OR=3.132)and elevated procalcitonin(OR=1.023)were risk factors for patient death.Conclusions Gram-negative bacteria play a significant role in the community acquired bloodstream infections of elderly patients.E.coli was the most common pathogenic bacteria.Type 2 diabetes mellitus and elevated procalcitonin were risk factors for mortality.