肠球菌血流感染的临床特征和预后因素分析

发布时间：2018-04-22 16:47

本文选题：肠球菌 + 血流感染　；参考：《中华医院感染学杂志》2017年09期

【摘要】：目的探讨肠球菌血流感染(BSI)的危险因素、临床特点、药物敏感性及预后因素,为临床治疗提供参考依据。方法回顾性分析2011年10月1日-2016年10月1日医院89例肠球菌BSI患者的临床资料,包括人口学情况、基础病、治疗、药敏和一般实验室检查资料;89例肠球菌BSI患者中30d死亡者32例(死亡组),余下57例患者为存活组。结果 89株肠球菌中,屎肠球菌37株,粪肠球菌52株;肠球菌BSI的易感因素:静脉置管、近期手术史、留置尿管、胃肠道感染、肺部感染;屎肠球菌和粪肠球菌对万古霉素和利奈唑胺的敏感率均为100.0%,屎肠球菌对青霉素G和氨苄西林的敏感率14.0%,粪肠球菌对青霉素G和氨苄西林的敏感率80.0%;肠球菌BSI 30d病死率为36.0%;单因素分析发现,存活组在年龄、合并脑血管病、冠心病、恶性肿瘤、免疫抑制治疗、慢性肾病、慢性肺病、留置导尿液、肺部感染、肝胆胰感染、血尿素、肌酐、降钙素原、低血压、无创机械通气、有创机械通气、使用血管活性药物、屎肠球菌感染方面低于死亡组;在血小板、白蛋白、氧合指数、合理抗感染治疗方面高于死亡组,两组差异有统计学意义(P0.05);logistic回归分析发现,慢性肾病、恶性肿瘤、屎肠球菌感染是肠球菌BSI死亡的独立危险因素,而合理的抗感染治疗是保护因素。结论屎肠球菌和粪肠球菌对万古霉素和利奈唑胺仍保持着高敏感性,但屎肠球菌的耐药性要高于粪肠球菌;慢性肾病、恶性肿瘤、屎肠球菌感染是肠球菌BSI死亡的独立危险因素,合理抗感染治疗是肠球菌BSI死亡的独立保护因素。
[Abstract]:Objective to investigate the risk factors, clinical characteristics, drug sensitivity and prognostic factors of Enterococci blood stream infection (BSII), and to provide reference for clinical treatment. Methods the clinical data of 89 patients with enterococcal BSI from October 1, 2011 to October 1, 2016 were retrospectively analyzed, including demography, basic diseases and treatment. Drug sensitivity and general laboratory examination data showed that 32 of 89 enterococcus BSI patients died on 30 days (death group, 57 cases survived group). Results among the 89 strains of Enterococcus faecium, 37 were Enterococcus faecium and 52 were Enterococcus faecalis. The susceptible factors of Enterococcus BSI were venous catheterization, recent surgical history, indwelling urethral catheter, gastrointestinal tract infection and pulmonary infection. The sensitivities of Enterococcus faecium and Enterococcus faecalis to vancomycin and linazolamine were both 100.0, the sensitivity rate of Enterococcus faecium to penicillin G and ampicillin was 14.0, the sensitivity rate of Enterococcus faecalis to penicillin G and ampicillin was 80.00.The sensitivity rate of Enterococcus faecium to penicillin G and ampicillin was 80.0. The mortality rate was 36.0; the univariate analysis showed that, Survival groups were aged, complicated with cerebrovascular disease, coronary heart disease, malignant tumor, immunosuppressive therapy, chronic nephropathy, chronic pulmonary disease, indwelling catheterization, pulmonary infection, hepatobiliary and pancreatic infection, blood urea, creatinine, procalcitonin, hypotension, Noninvasive mechanical ventilation, invasive mechanical ventilation, use of vasoactive drugs, infection of Enterococcus faecium were lower than those in the death group, platelet, albumin, oxygenation index, rational anti-infection treatment were higher than those in the dead group. Logistic regression analysis showed that chronic nephropathy, malignant tumor and Enterococcus faecium infection were independent risk factors for BSI death of Enterococcus faecium, and reasonable antiinfective therapy was the protective factor. Conclusion Enterococcus faecium and Enterococcus faecalis remain highly sensitive to vancomycin and linazolamide, but the drug resistance of Enterococcus faecium is higher than that of Enterococcus faecalis. Enterococcus faecium infection is an independent risk factor for the death of Enterococcus BSI, and rational antiinfective therapy is an independent protective factor for the death of Enterococcus BSI.
【作者单位】：北京积水潭医院感染疾病科;北京积水潭医院检验科;
【分类号】：R515

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