金黄色葡萄球菌血流感染患者的临床特征及发生脓毒性休克的危险因素和预测指标分析

Clinical characteristics of patients with Staphylococcus aureus bloodstream infection and analysis of risk factors and predictive indicators for the development of septic shock

目的探讨金黄色葡萄球菌血流感染患者的临床特征及发生脓毒性休克的危险因素。方法将2018年1月至2023年3月于该院诊断为金黄色葡萄球菌血流感染的51例患者纳入研究,根据患者是否发生脓毒性休克,将其分为脓毒性休克组和非脓毒性休克组。收集患者临床资料,于患者血培养标本留取当日进行临床实验室指标的检测。对从患者血培养标本中分离得到的细菌进行鉴定和药敏试验。对两组患者的临床资料及临床实验室检测指标进行比较。采用多元Logistic回归分析金黄色葡萄球菌血流感染患者发生脓毒性休克的独立危险因素。使用受试者工作特征(ROC)曲线分析临床实验室检测指标对金黄色葡萄球菌血流感染患者发生脓毒性休克的预测价值。结果51例患者发生脓毒性休克12例,发生率为23.5%。脓毒性休克组合并糖尿病、痛风性关节炎者占比,有长期糖皮质激素使用史者占比、有呼吸道感染者占比、死亡者占比、住院费用均高于非脓毒性休克组,差异有统计学意义(P<0.05)。长期糖皮质激素使用史是金黄色葡萄球菌血流感染发生脓毒性休克的独立危险因素(P<0.05)。C反应蛋白(CRP)、清蛋白(Alb)、中性粒细胞/淋巴细胞比值(NLR)和降钙素原(PCT)联合预测金黄色葡萄球菌血流感染患者发生脓毒性休克有较高的价值,ROC曲线下面积为0.983。结论长期使用糖皮质激素会导致金黄色葡萄球菌血流感染患者发生脓毒性休克的风险增高,CRP、Alb、NLR和PCT联合检测比单项检测对金黄色葡萄球菌血流感染患者发生脓毒性休克有更高的预测价值。

Objective To investigate the clinical features of of patients with Staphylococcus aureus bloodstream infection and risk factors for septic shock.Methods A total of 51 patients diagnosed with Staphylococcus aureus bloodstream infection in the hospital from January 2018 to March 2023 were enrolled in the study.According to whether the patients developed septic shock,they were divided into septic shock group and non-septic shock group.The clinical data of the patients were collected,and the clinical laboratory indicators were detected on the day of blood culture samples were collected.Bacteria isolated from blood culture specimens of patients were identified and tested for drug sensitivity.The clinical data and clinical laboratory test indicators of the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of septic shock in patients with Staphylococcus aureus bloodstream infection.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of clinical laboratory test indicators for septic shock in patients with Staphylococcus aureus bloodstream infection.Results Septic shock occurred in 12 of 51 patients,with an incidence of 23.5%.The proportion of patients with diabetes,gouty arthritis,the proportion of patients with long-term glucocorticoid use,the proportion of patients with respiratory tract infection,the proportion of patients who died,and the hospitalization cost in the septic shock group were higher than those in the non-septic shock group,and the differences were statistically significant(P<0.05).Long-term glucocorticoid use was an independent risk factor for septic shock in Staphylococcus aureus bloodstream infection(P<0.05).The combination of C-reactive protein(CRP),albumin(Alb),neutrophil/lymphocyte ratio(NLR)and procalcitonin(PCT)had high value in predicting septic shock in patients with Staphylococcus aureus bloodstream infection,and the area under the ROC curve was 0.983.Conclusion Long-term use of glucocorticoids can lead to an increased risk of septic shock in patients with Staphylococcus aureus bloodstream infection.The combined detection of CRP,Alb,NLR and PCT has a higher predictive value than single detection for septic shock in patients with Staphylococcus aureus bloodstream infection.