老年血流感染患者死亡的危险因素分析

Analysis of Risk Factors for Death in Elderly Patients with Bloodstream Infection

目的了解老年血流感染(BSI)的病原菌分布及临床特点,探讨老年BSI死亡的相关危险因素。方法2018年11月-2019年11月确诊为BSI的151例老年患者,回顾性分析患者的临床资料、合并疾病、侵袭性操作、实验室检查和治疗转归,分析死亡的危险因素。结果151例老年BSI患者共分离出165株菌株,其中革兰氏阴性菌49.70%(82/165)、革兰氏阳性菌37.58%(62/165)、真菌12.73%(21/165)。最常见的菌株依次为肺炎克雷伯菌(12.73%)、大肠埃希菌(12.12%)、屎肠球菌(5.45%)、白念珠菌(5.45%)和金黄色葡萄球菌(4.85%)。老年BSI患者的死亡率为27.81%。入住重症监护室(P=0.021)、机械通气(P=0.000)、慢性肾功能不全(P=0.002)和低蛋白血症(P=0.048)为老年BSI预后的独立危险因素。结论老年BSI死亡的独立危险因素可能为入住重症监护室、机械通气、慢性肾功能不全和低蛋白血症。

Objective To investigate the pathogen distribution and clinical features of blood stream infection(BSI)in elderly patients and explore the risk factors of BSI death in these patients.Methods A retrospective review of clinical data,comorbidity disease,invasive procedure,microbiologic results,and clinical outcome was conducted in 151 elderly patients with confirmed BSI from Nov 2018 to Nov 2019.The risk factors for death were analyzed.Results 165 strains were isolated from151 elderly patients with BSI.The Gram-negative bacteria,Gram-positive bacteria,and fungi accounted for 49.70%(82/165),37.58%(62/165),and 12.73%(21/165),respectively.The most common pathogen was Klebsiellapneumoniae(12.73%),Escherichia coli(12.12%),Enterococcus faecium(5.45%),Candida albicans(5.45%),and Staphylococcus aureus(4.85%).The mortality was 27.81%.Multivariable regression analysis revealed that admitting to ICU(P=0.021),receiving mechanical ventilation(P=0.000),chronic renal failure(P=0.002),hypoalbuminemia(P=0.048)were significant risk factors for death in elderly BSI patients.Conclusions Admitting to ICU,receiving mechanical ventilation,chronic kidney disease,and hypoalbuminemia are the independent risk factors for death in elderly BSI patients.