医院获得性革兰阳性球菌血流感染的耐药性及预后影响因素分析

The drug resistance and prognostic factors of nosocomial gram-positive cocci with bloodstream infection

目的分析医院获得性革兰阳性球菌血流感染的耐药性及预后影响因素.方法收集2010年1月至2016年12月确诊为医院获得性革兰阳性球菌血流感染病例的临床资料,分析其菌株耐药情况,采用多因素Logistic回归分析影响患者28d死亡的独立危险因素.结果医院获得性革兰阳性球菌血流感染患者共301例,导管相关性血流感染(CRBSI)发生率为21.26%,28d死亡率23.26%;其中凝固酶阴性葡萄球菌占40.53%(122/301),金黄色葡萄球菌感染占27.91%(84/301),肠球菌占31.56%(95/301).耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性菌(MRCNS)检出率分别是44.05%(37例)、73.77%(90例),耐万古霉素肠球菌株17.89%(17例),耐利奈唑胺肠球菌7.37%(7例).多因素Logistic回归分析:未早期拔除深静脉导管(OR=2.195,95%CI:1.152~4.184,P=0.017)、深静脉导管留置(OR=2.686,95%CI:1.240~5.822,P=0.012)、未早期合理使用抗菌药物(OR=1.988,95%CI:1.101~3.590,P=0.023)、肠球菌感染(OR=2.554,95%CI:1.433~4.549,P=0.001)是影响医院获得性革兰阳性菌球菌感染患者28d预后的独立危险因素.结论早期拔除深静脉导管、合理使用抗菌药物、减少肠球菌感染可降低医院获得性革兰阳性球菌血流感染病死率.

Objective To analyze the drug resistance and prognostic factors of hospital-acquired Gram-positive cocci infection.Methods To analyze the drug resistance and prognostic factors of hospital-acquired Gram-positive cocci infection.Methods The clinical data of hospital-acquired Gram-positive cocci infections from January 2010 to December 2016 were collected.The drug resistance of the strains was analyzed.Multivari?ite logistic regression analysis was used to analyze the independent risk Victors affecting patients'28-day mortality.Results A total of 301 patients with acquired Gram-positive cocci infection were found in the hospit?il.The incidence of catheter-related bloodstream infection(CRBSI)was 21.26%,and the 28-day mortality was 23.26%.Among them,coagulate-negative staphylococci accounted for 40.53%(122/301),Staphylococcus aureus infection accounted for 27.91%(84/301),Enterococcus accounted for 31.56%(95/301).The detection rates of methicillin-resistant Staphylococcus aureus(MRSA)and niethicillin-resistant coagulase-negative bacteria(MRCNS)were 44.05%(37 cases),73.77%(90 cases),and vancomycin-resistant enterococci was 17.89%(17cases),7.37%of endococci-resistant Enterococcus(7 cases).Multivariate logistic regression analysis:deep venous catheter was not removed early(OR=2.195,95%Cl:1.152~4.184,P=0.017),deep vein catheter indwelling(OR=2.686,95%Cl:1.240-5.822,P=0.012),early use of antibiotics(OR=1.988,95%Cl:1.101-3.590,P=0.023),enterococci infection(OR=2.554,95%Cl:1.433?4.549,P=0.001)was affecting hospital access Independent risk factors for prognosis in patients with gram-positive bacterium infection for 28 days.Conclusion Early removal of deep venous catheters,early rational use of antibiotics,and reduction of*enterococci infections can reduce the mortality rate of hospital-acquired Gram-positive cocci infection.