85岁以上高龄血流感染患者病原菌分布及死亡因素分析

Species distribution of bloodstream infection in the oldest old and factors associated with death

背景血流感染(bloodstream infection,BSI)是全球范围内常见的感染性疾病。近年来老年人群BSI的发病率及死亡率居高不下,造成了沉重的疾病负担。目的分析85岁及以上高龄血流感染患者的病原菌分布及死亡危险因素,为高龄BSI患者的临床治疗和预后判断提供依据。方法回顾性分析解放军总医院第一医学中心2017年1月-2019年12月所有确诊为BSI的85岁及以上住院患者的病原菌分布及临床结局,通过logistic回归分析患者死亡危险因素。结果共318例患者纳入研究,平均年龄(89.32±3.02)岁,共分离出345株菌株,其中革兰阴性菌168株(48.69%),革兰阳性菌155株(44.93%),真菌24株(6.38%)。常见病原菌依次为凝固酶阴性葡萄球菌(31.30%)、肺炎克雷伯菌(14.49%)、大肠埃希菌(13.62%)、鲍曼不动杆菌(6.67%)、肠球菌属(5.51%)。多因素logistic回归分析显示,合并5种及以上基础疾病(OR=1.641,95%CI=1.376~2.219,P=0.013)、有创机械通气(OR=1.628,95%CI=0.532~3.036,P=0.006)与85岁及以上BSI患者28 d内死亡独立相关。结论85岁及以上BSI患者常见病原菌包括凝固酶阴性葡萄球菌、肺炎克雷伯菌和大肠埃希菌等,合并5种及以上基础疾病、有创机械通气与高龄BSI患者死亡相关。

Background Bloodstream infection(BSI)is a common infectious disease worldwidely.In recent years,the morbidity and mortality of BSI in elderly patients are high,resulting in a heavy disease burden.Objective To investigate the clinical manifestation,species distribution and factors associated with bloodstream infection(BSI)in the oldest old(≥85 years old)patients,so as to provide evidence for clinical treatment and improve prognosis of elderly patients with BSI.Methods Clinical data about all the oldest old patients diagnosed with BSI in Chinese PLA General Hospital from January 2017 to December 2019 were retrospectively analyzed.Logistic regression analysis was used to determine the independent associated factors of 28-day death.Results A total of 318 oldest old patients with BSI were enrolled in this study,with an average age of 89.32±3.02 years.Three hundred and forty five strains were isolated,including 168 strains of gram-negative bacteria(48.69%),155 strains of gram-positive bacteria(44.93%)and 24 strains of fungi(6.38%).The most common pathogens were coagulase negative staphylococci(31.30%),Klebsiella pneumoniae(14.49%),Escherichia coli(13.62%),Acinetobacter baumannii(6.67%)and Enterococcus(5.51%).Multivariable logistic regression analysis showed that with≥5 comorbidities(OR=1.641,95%CI=1.376-2.219,P=0.013),invasive mechanical ventilation(OR=1.628,95%CI=0.532-3.036,P=0.006)were associated with death within 28 days in BSI patients aged 85 years and older.Conclusion Common pathogens of BSI in oldest old patients include coagulase-negative Staphylococcus,Klebsiella pneumoniae and Escherichia coli,etc.,Combined with five or more comorbidities and invasive mechanical ventilation are associated with death in these patients.