嗜麦芽窄食单胞菌感染相关死亡危险因素分析

Risk Factors Related to Death Induced by Stenotrophomonas Maltophilia Infection

目的探讨嗜麦芽窄食单胞菌(SMA)感染相关死亡的危险因素。方法选取某三级综合医院2018年至2019年收治的SMA感染患者289例,根据患者临床转归结局分为死亡组(41例)和生存组(248例),收集两组患者可能与SMA感染死亡相关的一般资料,包括性别,年龄,基础疾病状态,是否入住重症监护室,快速序贯器官衰竭(qSOFA)评分,是否伴发脓毒血症、多器官功能障碍综合征(MODS)、低蛋白血症和低氧血症,是否混合其他细菌感染,抗菌药物治疗情况等,采用单因素分析法筛选SMA感染相关死亡的可能危险因素,采用多因素Logistic回归模型分析SMA感染相关死亡的独立危险因素。结果符合诊断标准的289例患者中,SMA感染相关的总体病死率为14.19%(41/289)。单因素分析结果显示,qSOFA=3分,进行机械通气,合并心血管疾病,伴发脓毒血症、MODS、低蛋白血症,混合其他细菌感染,使用碳青霉烯类抗菌药物与SMA感染相关死亡显著相关(P<0.05)。多因素Logistic回归分析结果显示,qSOFA评分=3分[OR=4.760,95%CI(1.646,13.765),P=0.004],合并心血管疾病[OR=5.421,95%CI(1.365,21.525),P=0.016],伴发脓毒血症[OR=2.913,95%CI(1.027,8.264),P=0.044],伴发MODS[OR=3.605,95%CI(1.404,9.258),P=0.008],伴发低蛋白血症[OR=2.895,95%CI(1.304,6.424),P=0.009]是SMA感染相关死亡的独立危险因素。结论临床积极和综合诊治脓毒血症、MODS和低蛋白血症,降低qSOFA评分,改善心血管疾病状态,有利于降低SMA感染的死亡率。

Objective To investigate the risk factors related to the death induced by Stenotrophomonas maltophilia(SMA)infection.Methods A total of 289 patients infected with SMA in a tertiary general hospital from 2018 to 2019 were selected and divided into the death group(41 cases)and the survival group(248 cases)according to different clinical outcomes.The general data of patients in the two groups that might be related to the death induced by SMA infection were collected,including sex,age,basic disease status,whether admitted to the intensive care unit,score of quick sequential organ failure assessment(qSOFA),whether concomitant with sepsis,multiple organ dysfunction syndrome(MODS),hypoproteinemia and hyoxemia,whether co-infected with other bacteria,antibacterial therapy and so on.The univariate analysis was used to screen the possible risk factors related to the death induced by SMA infection,and the multivariate Logistic regression model was used to analyze the independent risk factors related to the death induced by SMA infection.Results Among 289 patients whose disease met the diagnostic criteria,the overall mortality related to the SMA infection was 14.19%(41/289).The univariate analysis showed that the qSOFA score=3 points,mechanical ventilation,complicated with cardiovascular disease,concomitant with sepsis,MODS and hypoproteinemia,co-infected with other bacteria and use of carbapenem antibiotics were significantly related to the death induced by SMA infection(P<0.05).The multivariate Logistic regression analysis showed that qSOFA score=3 points[OR=4.760,95%CI(1.646,13.765),P=0.004],complicated with cardiovascular disease[OR=5.421,95%CI(1.365,21.525),P=0.016],concomitant with sepsis[OR=2.913,95%CI(1.027,8.264),P=0.044],concomitant with MODS[OR=3.605,95%CI(1.404,9.258),P=0.008]and concomitant with hypoproteinemia[OR=2.895,95%CI(1.304,6.424),P=0.009]were independent risk factors related to the death induced by SMA infection.Conclusion We should diagnosis and treat sepsis,MODS and hypoproteinemia actively,decrease qSOFA score and improve the cardiovascular disease status in the clinic,which is helpful to decrease the mortality of patients infected with SMA.