成人耐碳青霉烯革兰阴性菌血流感染临床特征及死亡危险因素分析

发布时间：2018-04-17 05:32

本文选题：碳青霉烯类 + 革兰阴性菌　；参考：《中国抗生素杂志》2017年03期

【摘要】：目的探讨碳青霉烯类耐药革兰阴性菌(CR-GNB)血流感染的临床特征及死亡危险因素,为临床耐药菌感染合理治疗提供依据。方法回顾性调查2014年7月—2016年6月四川大学华西医院明确诊断的CR-GNB血流感染患者157例,根据致病菌是否为广泛耐药,分为XDR组及非XDR组,分析其临床特征及治疗方案,并对CR-GNB血流感染者临床转归进行多因素Logistic回归分析。结果 CR-GNB血流感染者XDR组68例,非XDR组89例。患者主要分布在ICU病房及血液科,基础疾病以重症胰腺炎及肿瘤多见。CR-GNB血流感染全因病死率55.41%,XDR组高于非XDR组(P0.05)。CR-GNB以鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌多见。根据药敏结果调整治疗方案似能改善CR-GNB血流感染者的临床转归,但差异无统计学意义(P0.05)。多因素Logistic回归分析显示,年龄65岁(OR=3.059,95%CI 1.117~8.380)及入住重症监护病房(ICU)(OR=2.541,95%CI 1.179~5.477)是CR-GNB血流感染患者死亡的可能危险因素(P0.05)。结论目前CR-GNB感染形势严峻,入住ICU的高龄患者预后差,需要加强各种感控措施,尽量延缓或避免CR-GNB的产生与感染,需积极探索新的治疗方法,提高疗效。
[Abstract]:Objective to investigate the carbapenem resistant gram negative bacteria (CR-GNB) clinical characteristics and death risk factors of bloodstream infection, provide the basis for clinical reasonable treatment for drug-resistant bacterial infections. Methods the diagnosis of CR-GNB bloodstream infections of 157 patients from July 2014 to June 2016 in West China Hospital of Sichuan University, according to the pathogen is widely divided into resistance. XDR group and non XDR group, to analyze the clinical features and treatment, and the clinical CR-GNB bloodstream infection in multivariate Logistic regression analysis. Results the outcome of CR-GNB bloodstream infection, 68 cases in XDR group and non XDR group 89 cases. Patients are mainly distributed in the ICU ward and Department of Hematology, basic diseases in severe acute pancreatitis and tumor. All-cause mortality 55.41%.CR-GNB bloodstream infection in XDR group was higher than that in non XDR group (P0.05.CR-GNB) by Bauman Acinetobacter, Pseudomonas aeruginosa and Escherichia coli. According to the results of drug sensitivity adjustment The whole treatment can improve clinical outcomes like CR-GNB bloodstream infection, but the difference was not statistically significant (P0.05). Multivariate Logistic regression analysis showed that the age of 65 years (OR=3.059,95%CI 1.117~8.380) and ICU (ICU) (OR=2.541,95%CI 1.179~5.477) CR-GNB bloodstream infection risk factors of death in patients with (P0.05) conclusion. At present, CR-GNB infection situation is grim, the prognosis of elderly patients admitted to the ICU, the need to strengthen the sense of various control measures to delay or avoid the generation of CR-GNB and infection, to actively explore new methods of treatment, improve the curative effect.

【作者单位】：四川大学华西医院感染性疾病中心;四川大学华西医院实验医学科;
【基金】：高度耐药菌防控产品及监测系统研究(国家科技支持计划课题,No.2012EP001000)
【分类号】：R446.5

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