孙逸仙纪念医院血液内科,广东,广州,510120
网络首发:2017-07-20,
纸质出版:2017
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张国扬, 杨鹏凤, 王秀菊, 等. 血液病住院患者血流感染死亡危险因素分析[J]. 中山大学学报(医学科学版), 2017,38(4).
Risk Factors for Mortality of Bloodstream Infections in Patients with Hematologic Diseases[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(4).
【目的】分析血液病住院患者发生血流感染死亡相关的危险因素,为临床评估病情、合理干预及改善预后提供 依据。【方法】回顾性分析 2012 年 1 月到 2016 年 6 月发生血流感染的血液病患者临床特征及死亡相关的危险因素,采用 SPSS 19.0统计软件进行数据处理。【结果】共纳入242例次血培养阳性血流感染患者,分离出266株病原菌,其中革兰阳性 菌99株(37.2%),革兰阴性菌164株(61.7%),真菌3株(1.1%)。血流感染患者死亡42例(17.4%),Logistic多因素回归分析 显示原发病活动状态(P = 0.007,OR = 5.622,95% CI 1.586 ~ 19.924)、出现感染性休克(P = 0.007,OR = 4.978,95% CI 1.560 ~ 15.884)、合并心功能不全(P = 0.001,OR = 11.878,95% CI 2.760 ~ 51.120)、白蛋白水平<35 g/L(P = 0.036,OR = 3.468, 95% CI 1.087 ~ 11.066)、多种病菌感染(P = 0.010,OR = 6.024,95% CI 1.540 ~ 23.563)以及感染病菌为肠球菌属(P = 0.002, OR = 15.266,95% CI 2.817 ~ 82.728)或溶血性葡萄球菌(P = 0.001,OR = 19.308,95% CI 3.392 ~ 109.888)为死亡独立危险因 素。Kaplan-Meier生存分析显示,不恰当的初始经验性抗菌治疗及具备任何一个上述危险因素的患者总体病死率明显升 高。【结论】血液病患者血流感染病原菌种类多,多重耐药菌检出率高,死亡率高。及时并合理使用抗菌药物、积极治疗原 发病、改善心功能和及时纠正低蛋白血症是改善预后的关键措施。
【Objective】To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases,so as to provide evidence for reasonable and effective application of treatments.【Methods】The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively,then the analysis was performed for risk factors. The statistical analysis was processed by SPSS 19.0.【Results】A total of 266 strains of pathogens were isolated,including 99 strains of gram-positive bacteria,accounting for 37.2%,and 164 strains of gram-negative bacteria,account? ing for 61.7%. Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases(P = 0.007,OR = 5.622,95% CI 1.586 ~ 19.924),presentation with septic shock(P = 0.007,OR = 4.978,95% CI 1.560 ~ 15.884),cardiac insufficiency(P = 0.001,OR = 11.878,95% CI 2.760 ~ 51.120),level of albumin less than 35 g/L(P = 0.036, OR = 3.468,95% CI 1.087 ~ 11.066),polymicrobial infection(P = 0.010,OR = 6.024,95% CI 1.540 ~ 23.563),and Staphylococ? cus haemolyticus(P = 0.001,OR = 19.308,95% CI 3.392 ~ 109.888)/Enterococcus(P = 0.002,OR = 15.266,95% CI 2.817 ~ 82.728)infection. The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group.【Conclusions】Bloodstream infections in pa?tients may cause high mortality rate,so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.
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