糖尿病合并血流感染的病原学特征及预后危险因素分析

Etiological characteristics of diabetes mellitus complicating bloodstream infections and prognostic risk factors analysis

目的探讨糖尿病合并血流感染的病原学特征及预后危险因素,为临床早期经验性抗感染治疗提供参考。方法回顾性分析绵阳市第三人民医院/四川省精神卫生中心2018年1月1日至2020年12月31日收治的糖尿病合并血流感染患者,使用WHONET5.6统计其病原菌分布及药物敏感性。按照感染发生后90 d内疾病转归分为生存组和死亡组,分析出现不良预后的危险因素。结果共纳入糖尿病合并血流感染患者170例,以社区获得性感染为主(82.94%),女性占61.76%,中位年龄68岁。共分离出病原菌172株,以大肠埃希菌(44.77%)和肺炎克雷伯菌(23.84%)最为常见。大肠埃希菌对氨苄西林、哌拉西林、头孢唑啉的耐药率均高于50.00%,对头孢曲松、头孢噻肟的耐药率均为44.16%,对头孢替坦、哌拉西林/他唑巴坦、米诺环素等的耐药率均低于10.00%;肺炎克雷伯菌对头孢曲松、头孢噻肟的耐药率均为26.83%,对头孢他啶、头孢吡肟、头孢替坦等的耐药率均低于10.00%,有1株碳青霉烯类耐药肺炎克雷伯菌。糖尿病合并血流感染多继发于泌尿系统(44.71%),其合并有自主神经损伤的比例明显高于其他感染类型,且女性多于男性(P<0.05)。死亡组患者的舒张压、收缩压,血清总蛋白、白蛋白水平及使用胰岛素控制血糖的比例均低于生存组,死亡组患者入住重症监护病区(ICU)的比例高于生存组(P<0.05);血清总蛋白、白蛋白水平,入住ICU病区及使用胰岛素控制血糖是影响患者预后的独立危险因素。结论糖尿病合并血流感染的病原菌以大肠埃希菌、肺炎克雷伯菌多见,其耐药性较为严重,应加强院感防控和监测。

Objective To investigate the etiological characteristics and prognostic risk factors of diabetes mellitus(DM)complicating bloodstream infections in order to provide reference for early empirical anti-infective treatment.Methods The patients with DM complicating bloodstream infections admitted to Mianyang Municipal Third People’s Hospital/Sichuan Provincial Mental Health Center from january 1,2018 to December 31,2020 were analyzed retrospectively.WHONET5.6 was used to statistically analyze the distribution of pathogenic bacteria and drug sensitivity.According to the outcomes of the disease within 90 d after infection,the patients were divided into the survival group and death group,and the risk factors of poor prognosis appearance were analyzed.Results A total of 170 patients with DM complicating bloodstream infections were included,which was dominated by community-acquired infections(82.94%),female accounted for 61.76%,the median age was 68 years old.A total of 172 strains of pathogenic bacteria were isolated,in which Escherichia coli(44.77%)and Klebsiella pneumoniae(23.84%)were the most common.The resistance rate of Escherichia coli to ampicillin,piperacillin and cefazolin was higher than 50.00%,which to ceftriaxone and cefotaxime were 44.16%,which to cefotetan,piperacillin/tazobactam,minocycline,etc.were less than 10.00%.The resistance rates of Klebsiella pneumoniae to ceftriaxone and cefotaxime were both 26.83%,which to ceftazidime,cefepime and cefotetan were less than 10.00%.There was one strain of carbapenem resistant Klebsiella pneumoniae.DM complicating bloodstream infections were mostly secondary to the urinary system(44.71%),the proportion of complicating autonomic nerve injury was significantly higher than that in other types of infections,moreover the female was more than the male(P<0.05).The blood vessel diastolic blood pressure,systolic blood pressure,levels of serum total protein and albumin,and the proportion of using insulin to control blood glucose in the death group were lower than those in the survival group,while the proportion of the patients admitting to intensive care unit(ICU)in the death group was higher than that in the survival group(P<0.05).The levels of serum total protein and albumin,staying in the ICU ward and using insulin for controlling blood glucose were the independent risk factors affecting the prognosis of the patients.Conclusion Escherichia coli and Klebsiella pneumoniae are the most common pathogens of DM complicating bloodstream infections,and their drug resistance is serious,so the prevention,control and surveillance of nosocomial infection should be strengthened.