糖肽类药物治疗甲氧西林敏感金黄色葡萄球菌血流感染的临床特点及预后分析

Clinical characteristics and prognosis of glycopeptide in the treatment of methicillin sensitive Staphylococcus aureus bloodstream infection

目的 探讨糖肽类药物治疗甲氧西林敏感金黄色葡萄球菌(MSSA)血流感染的临床特点、患者结局及死亡危险因素。方法 分析2017年1月至2022年2月东莞东华医院诊断为MSSA血流感染的成人住院患者病例,比较接受糖肽类和非糖肽药物治疗患者的临床资料及相关实验室数据,并应用多因素logistic回归分析死亡的危险因素。结果 共纳入MSSA血流感染患者101例,其中接受糖肽类药物治疗患者30(29.7%)例,非糖肽药物治疗71(70.3%)例。糖肽类药物组患者进行机械通气(χ^(2)=7.015,P=0.008)、深静脉置管(χ^(2)=4.488,P=0.034)、入住ICU(χ^(2)=11.634,P=0.001)、发生脓毒性休克(χ^(2)=4.668,P=0.031)、抗感染疗程(t=-3.167,P=0.002)和抗菌药物费用(t=-5.039,P=0.000)明显多于非糖肽类药物组,差异有统计学意义(P<0.05)。死亡率、住院天数等比较差异无统计学意义(P>0.05)。多因素logistic回归分析显示Pitt评分(OR=2.125,95%CI:1.164~3.882,P=0.014)是MSSA血流感染患者死亡的独立危险因素。结论 糖肽类药物与非糖肽类药物治疗MSSA血流感染患者的死亡率没有明显差异,但糖肽类药物可使抗感染疗程更长及抗菌药物费用增加。在临床实践中,应结合指南和患者具体情况尤其Pitt评分,合理使用抗菌药物,早期给予正确的治疗。

Objective To investigate the clinical characteristics,outcomes and risk factors of mortality of glycopeptide in the treatment of methicillin-susceptible Staphylococcus aureus(MSSA)bloodstream infection. Methods A retrospective study was carried out on adult hospitalized patients of Dongguan Tungwah Hospital with MSSA bloodstream infection from January 2017 to February 2022. The clinical and relevant laboratory data of patients treated with glycopeptides and non-glycopeptides were compared,and the risk factors predicting the mortality were analyzed by multivariate logistic regression. Results A total of 101 patients with MSSA bloodstream infection were included,including 30(29.7%)with glycopeptide treatment and 71(70.3%)without glycopeptides treatment. The glycopeptides group was significantly higher than the non-glycopeptides group in the rates of mechanical ventilation(χ^(2)=7.051,P=0.008),deep vein catheterization(χ^(2)=4.488,P=0.034),ICU admission(χ^(2)=11.634,P=0.001),septic shock(χ^(2)=4.668,P=0.031),length of anti-infective(t=3.167,P=0.002)and cost of antibiotics(t=5.039,P=0.000),but the mortality rate and days of hospital stay were not significantly different. Multivariate logistic regression analysis showed that Pitt score(OR=2.125,95% CI:1.164~3.882,P=0.014)was an independent risk factor for the death of patients with MSSA bloodstream infection. Conclusion There is no significant difference in mortality between glycopeptides and nonglycopeptides treatment in patients with MSSA bloodstream infection,but glycopeptide drugs could increase the course of anti-infection and the cost of antibiotics. In clinical practice,the guidelines and the specific conditions of the patients,especially the Pitt score,should be combined with the rational use of antibiotics,and the correct treatment should be given early.