头孢哌酮/舒巴坦对耐碳青霉烯革兰阴性菌血流感染患者临床结局的影响

The impact of cefoperazone/sulbactam on clinical outcomes of patients with carbapenem-resistant gram-negative bacteria bloodstream infection

目的分析影响耐碳青霉烯类革兰阴性菌(carbapenem-resistant gram-negative bacteria,CRGNB)血流感染患者预后的因素,探讨头孢哌酮/舒巴坦对患者临床结局的影响。方法利用Whonet 5.6软件和山东第一医科大学第二附属医院电子病历系统检索我院2018年至2021年诊断为CRGNB血流感染患者的病历资料,应用SPSS 21.0软件进行统计学分析,应用单因素分析筛选影响患者预后的因素,应用logstic回归分析筛选影响患者预后的危险因素,并结合受试者工作特征(receiver operating characteristic,ROC)曲线行联合预测。结果共纳入56例CRGNB血流感染患者,单因素分析显示,死亡组和生存组在以下变量中差异均有统计学意义(P<0.05):抽取血培养时的急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHE Ⅱ)得分、快速Pitt菌血症(quick Pitt bacteremia score,qPitt)得分、快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA)得分、血流感染后使用呼吸机天数、抽取血培养后72~96 h的早期临床失败评价标准(early clinical failure criteria,ECFC)得分、血流感染后未接受舒巴坦制剂治疗、接受替加环素治疗;logistic回归分析显示,抽取血培养后72~96 h的ECFC得分增高和血流感染后接受替加环素治疗、未接受舒巴坦制剂治疗是影响预后的独立危险因素;行联合预测分析结果显示,ROC曲线下面积为0.903(95%CI:0.824~0.982),敏感度81.82%(18/22),特异度85.29%(29/34),准确度83.93%(47/58)。以是否应用头孢哌酮/舒巴坦进行差异性对比分析发现,应用组的患者死亡率明显低于非应用组,但两组住院28 d存活率差异无统计学意义。结论对于CRGNB血流感染的患者应用头孢哌酮/舒巴坦可能与较低的死亡风险相关,而使用替加环素可能会增加患者死亡率,发生血流感染后接受含头孢哌酮/舒巴坦方案治疗可能降低患者住院死亡率。

Objective:To analyze the factors affecting the prognosis of patients with carbapenem-resistant gramnegative bacteria(CRGNB)bloodstream infection,and to explore the effect of cefoperazone/sulbactam on clinical outcome in these patients.Methods:Medical records of patients diagnosed with CRGNB bloodstream infection from 2018 to 2021 were retrieved from Whonet 5.6 software and the electronic medical record system of the Second Affiliated Hospital of Shandong First Medical University.Statistical analysis was performed using SPSS 21.0 version.Univariate analysis was performed to screen the factors affecting the prognosis of patients,and logistic regression analysis was performed to screen the risk factors affecting the prognosis.The selected risk factors were joint predict the prognosis of these patients by ROC curve.Results:A total of 56 patients with CRGNB bloodstream infection were included.Univariate analysis showed that there were significant differences(P<0.05)between the death group and the survival group in APACHE II score,qPitt score,qSOFA score,ventilator days after bloodstream infection,ECFC score after blood culture extraction 72~96 h,unused of sulbactam formulation and used of tigecycline after bloodstream infection.Logistic regression analysis showed that ECFC score after blood culture extraction 72~96 h,unused of sulbactam formulation and used of tigecycline after bloodstream infection were independent risk factors for prognosis.The results of joint prediction analysis showed that the area under ROC curve was 0.903(95%CI:0.824~0.982),the sensitivity,the specificity and the accuracy were 81.82%(18/22),85.29%(29/34)and 83.93%(47/58)respectively.Conclusion:Cefoperazone/sulbactam may be associated with a lower risk of death in patients with CRGNB bloodstream infection,whereas tigecycline may increase mortality,and treatment with cefoperazone/sulbactam following bloodstream infection may reduce the incidence of in-hospital death.